1

Dear Upward Bound Parent/Guardian: This is an application to attend the 2012 Upward Bound Summer Academy at University of Alaska Anchorage. Your child must be a current member of Upward Bound in order to be in the Summer Academy. Even if your student is a current member of Upward Bound, you must complete this packet in order to be enrolled in the Summer Academy. If your student is not enrolled in Upward Bound, they must first complete the regular application and be accepted into the program. Please detach and keep pages 1-4 of this packet, as they contain important information about the Summer Academy. Complete remaining pages and return them directly to the Upward Bound office.

The Upward Bound Summer Component begins on Wednesday, May 23rd at 9:00am. We ask that you drop your student off on this and every morning at the UAA Multicultural Center, in Rasmuson Hall, Suite 106, between 8:00 – 9:00 am every morning, as this is where breakfast will be provided.

Classes will be held every Monday – Thursday from 9:00am – 4:30pm. Again, Students should be dropped off between 8:00 – 9:00 am at Rasmuson Hall for breakfast. Students must be picked up at the same location - Rasmuson Hall 106 - by 5:15pm. The last day of UB Summer Academy will be Friday, June 29th. This will also be the day students will showcase their work and all family members are invited to celebrate. Fridays are designated as our educational outing days. UB has lined up exciting learning experiences for our students. We hope these outings will peak their curiosity and expose them to new and beneficial opportunities. It is also important to note that for every 120 hours a student completes with Upward Bound within a semester’s time, the student receives .5 credit on their high school transcript. Upward Bound will also host a special trip to the University of Alaska Fairbanks (UAF). Students will have the opportunity to visit UAF and stay in the dormitory on campus. We will provide breakfast, lunch and snacks for the students during the academy. UB also pays for meals when we travel. If your child has any food allergies or dietary concerns please be sure to indicate this on the Medical Information section of the Parent/Guardian Form.

Finally, there is a mandatory Summer Academy Orientation Meeting on Friday, May 11th at 5:45pm – 7:00pm. The meeting will be held at Rasmuson Hall 101. Parents/Guardians and students must attend in order to discuss

summer expectations and complete additional paperwork not included in this packet. Thank you for allowing your student to attend. We will do our best to help each one have a good experience. If you have concerns that are not addressed here, please email us at success@uaa.alaska.edu or call us at 907-786-6124.

YOU MUST RETURN THE FORMS BELOW BY FRIDAY, MAY 4TH: STUDENT APPLICATION MEDICAL INFORMATION LEAVE PERMISSION FORM STUDENT EXPECTATIONS

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

2

Summer Academy Overview The Education Technology Revolution

Technology is playing a more important role in student education each year. According to a recent article in the Chicago Tribune, “access to technology helps students to become better 21st century learners.” With this in mind, the 2012 Upward Bound Summer Academy theme is The Education Technology Revolution (TETR). The goal of TETR is to expand Upward Bound students’ exposure and use of technology as a tool to enhance creativity and learning. Students will learn, create and collaborate using technology such as Accuplacer MyFoundations Lab, Roadtrip Nation and Google SketchUp. Finally, students will demonstrate their work on their personally developed Google Site website. Monday through Thursday, students will attend classes held primarily in the Rasmuson Hall Computer Lab in Room 216. This room boasts 37 DELL computers available for student use. On Fridays, Upward Bound will take cultural and educational trips around Anchorage. During the fifth week of TETR, Upward Bound students will take a trip to the University of Alaska Fairbanks. The TETR Summer Academy will culminate on June 29th and students will share their website and learning experiences with other UB families and distinguished guests. Classes begin Wednesday, May 23rd and end on Friday, June 29th. Students are required to attend all classes. Non-attendance for any reason (even illness) will reduce the number of hours of completion and could result in no credit. There is an expectation that students will work and complete the given projects. Any student who fails to participate will jeopardize not only his/her credit earnings, but also the opportunity for participating in future summer academies. If you are not actively participating in the Summer Academy, you may be sent home early and not allowed to complete the summer program. Upward Bound students will also participate in the President’s Challenge. The President’s Challenge helps people of all ages and abilities increase their physical activity and improve their fitness through research-based information, easy-to-use tools, and friendly motivation. Students will have one hour of physical activity each day. Unless there is a medical condition noted, all students are expected to participate. We encourage everyone to bring a change of clothes. The following page contains the Summer Academy schedule. During the first week, all students will take the Accuplacer Exam. This exam will assist us in placing students in the appropriate math courses. During this week, you will also be placed in the appropriate language and elective courses. Upward Bound will do its best to place you in the elective and language course of your choice, however, this may not always be possible.

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

3

Cultural  Trips  Friday,  May  25  –  Campbell  Creek  Science  Center  –  Leadership  Development  June  1  –  Planetarium  and  Goose  Creek  Trail  June  8  –  Loussac  Library,  Teen  Underground  June  15  –  UAA  Aviation  Technology  Tour  

*Monday, May 28th, is Memorial Day. In recognition of this holiday, UAA is closed and Upward Bound will not operate on this day.

2012 UPWARD BOUND SUMMER PROGRAM DAILY SCHEDULE The Ed Tech Revolution (TETR)

TIME AGENDA CLASS SCHEDULE

8am – 5pm Monday - Thursday

WK I – May 21st – 25th WK IV – June 11th – June 15th WK II – May 29th – June 1st * WK V – June 18th – June 22nd WK III – June 4th – June 8th WK VI – June 25th – June 29th

8am - 9am Breakfast 9am – 10:30am Classes Webcast Development

10:30am – 12pm Classes Accuplacer Foundations Lab

12pm – 1pm LUNCH

1pm – 2:30pm Classes Geomodeling and Google Site Development

2:30pm – 4pm Classes President’s Challenge (Physical Activity)

4 pm - 5 pm Road Trip Nation

WK I – Establishment of Expectations, Technology Usage Policies (In Accordance with CAS), Assessments, StrengthsQuest, Campus tour

WK V June 19 – June 22 (Monday, June 18th will be a trip preparation day) University of Alaska Fairbanks, Fairbanks, AK

WK VI June 25 – June 29 Assessments, finalizing Google Sites and presentation preparation

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

4

Course  Descriptions    Webcast  Development  Students  will  be  divided  into  groups.    Each  group  will  be  responsible  for  developing  a  video  project.    Projects  can  include  a  teen  talk  show,  Summer  Academy  in  review,  or  any  other  topic  that  deals  with  the  positive  impact  of  education.    Students  will  video,  edit,  record  and  finally  present  the  video  at  the  final  day  showcase.    Accuplacer  MyFoundations  Lab  Based  on  the  results  of  their  Accuplacer  Diagnostics  assessment,  the  Accuplacer  MyFoundations  Lab  generates  a  personalized  learning  path  for  each  student.    The  online  tool  offers  targeted  remediation  mapped  to  the  Diagnostic  competencies.    Students  can  work  at  their  own  pace  to  improve  skills.    Geomodeling  and  Google  Site  Development  Students  will  be  introduced  to  a  set  of  Google  tools  to  develop  geomodeling  projects.    Depending  on  the  student’s  skill  level,  this  can  vary  from  creating  a  3D  model  home  to  students  submitting  a  3D  building  model  for  GoogleEarth  model  submission.    Students  will  build  out  complete,  to  scale  homes  and  create  a  presentation  video  of  their  work.      Students  will  also  create  their  own  Google  Site  or  Wiki  to  showcase  of  their  work  during  TETR.    The  sites  will  be  shown  during  the  showcase.    Roadtrip  Nation  RoadtripNation.org  is  an  education  organization  with  curricula  focused  on  helping  high  school  students  explore  pathways  and  possibilities  for  their  future.    This  web-­‐based  program  gives  students  access  to  hundreds  of  videos  and  documents  that  allow  students  to  explore  the  number  of  possibilities  and  pathways  they  can  take  in  careers.    Students  will  end  this  course  by  interviewing  one  local  person  who  is  involved  in  a  career  they  are  considering.    President’s  Challenge  -­‐  Physical  Activity  Upward  Bound  students  will  participate  in  the  President’s  Challenge  in  the  goal  of  earning  the  Presidential  Active  Lifestyle  Award  (PALA+).        Students  only  need  to  commit  to  be  active  60  minutes  per  day,  5  days  per  week  for  6  out  of  8  weeks.    They  will  track  their  progress  on  the  online  personal  activity  log  and  we  will  participate  as  a  group.    For  more  information,  visit  www.presidentschallenge.org.        Physical  activity  will  take  place  everyday.    We  encourage  students  to  bring  a  change  of  clothes  and  the  appropriate  shoes  for  physical  activity.  

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

5

 

STUDENT APPLICATION Program Dates: May 23 to June 29, 2012

APPLICATION DEADLINE: Wednesday, May 4, 2012 CONTACT INFORMATION Student’s Name Student’s E-mail address Student’s Cell Phone ________________ Are you currently enrolled in Upward Bound? Yes No Parent/Guardian’s Name 1 Address ______________________________________________________________________ City State Zip code Home Phone Number ( ) - Work Phone Number ( ) _________________ Cell Phone Number ( ) - Email Address Parent/Guardian’s Name 2 Address ______________________________________________________________________ City State Zip code Home Phone Number ( ) - Work Phone Number ( ) _________________ Cell Phone Number ( ) - Email Address Are there any times, days or dates during the Summer Academy that you anticipate you will not be in attendance? If so, please list the days/dates and/or time: On the following lines, please tell us why you want to attend the Summer Academy? What are your goals? What do you hope to gain?

University of Alaska Fairbanks Trip – June 19 – 22, 2012 YES, I WILL BE ATTENDING THE UNIVERSITY OF ALASKA FAIRBANKS COLLEGE TRIP.

NO, I WILL NOT BE ATTENDING THE UNIVERSITY OF ALASKA FAIRBANKS COLLEGE TRIP.

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

6

       

MEDICAL INFORMATION

Student’s Name Date of Birth

MEDICAL INFORMATION Emergency Contact Name: ____________________ Relationship: ________ Home Ph: _____________ Cell Ph: ____________ Name: ____________________ Relationship: ________ Home Ph: _____________ Cell Ph: ____________ Name of Physician _____________________ Physician’s Telephone#______________ Physician’s Address____________________________________________________________ Is your child taking any medication that will need to be administered during Summer Academy: ____ No ____ Yes, enter dosage and frequency. Any Allergies: ___No _____Yes, please list Is there any other information we should know about your child's medical history? ____ No ____ Yes, explain _____________________________________________________ Can the student use mosquito repellant? Yes ___ No __ Can the student use sunscreen? Yes ___ No ___

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

Medical Permission I give my consent and permission for the Upward Bound Program staff to arrange for any necessary emergency medical treatment by qualified medical personnel for the above named student. I understand that before any emergency treatment is instituted, all reasonable effort will be made to contact me. ___________________________________ ____________________________ SIGNATURE OF PARENT/GUARDIAN DATE

7

   

LEAVE PERMISSION FORM Student’s Name Date of Birth I, give permission for my child , to be picked up by the individuals listed below, take public transportation and/or walk from the University of Alaska Anchorage Upward Bound Campus and/or Upward Bound Activities. Name: ____________________ Relationship: Ph: Name: ____________________ Relationship: Ph: Name: ____________________ Relationship: Ph: Does your child have permission to take public transportation? ____ No ____ Yes Does your child have permission to walk? ____ No ____ Yes

PLEASE NOTE: If anyone besides the individuals listed are to pick up the student, Upward Bound will require written notification granting permission. The parent/legal guardian must also inform Upward Bound staff prior to pick up if there is going to be an early departure.

UAA Upward Bound will not assume responsibility or liability for any accidents or occurrences after your child has been picked up or signed out. By signing below, the parent/legal guardian understands that neither Upward Bound nor the University of Alaska Anchorage is liable for anything that may occur. SIGNATURE OF PARENT/GUARDIAN DATE

Please be respectful of Upward Bound Staffing and their families - students are to be picked by 5:15pm

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

8

STUDENT EXPECTATIONS

We are very pleased to have you in the Upward Bound Summer Program. It is very important to us that students applying to this program understand the essential aspects of the University of Alaska Anchorage Upward Bound Program. We consider it a wonderful opportunity for all students but experience has taught us that the students who have most enjoyed our program came in with a basic understanding of its structure and purpose. For this reason, we ask that you initial each of the following statements and sign below. We also ask that your parent(s) or guardian read this through with you and sign below. Students Initial Here

↵ I understand that this program will help me prepare for a four-year college while exposing me to the opportunities available at UAA and other campuses.

↵ I understand that the program emphasizes discipline. I understand this means that administrators and program staff will supervise me constantly.

↵ I understand that students must treat staff and their peers with respect: the use foul language, physical contact or acting out will not be tolerated.

↵ I understand that I will be expected to regularly participate in the Upward Bound Summer Academy. I will not be able

to miss all week and show up for the cultural field trips.

↵ I understand that punctuality is necessary. I will arrive on time and keep my full day commitment.

↵ I understand that I will be expected to follow program rules, policies and regulations during my entire participation in Upward Bound.

↵ I understand that the program may, at times, include physical recreation and certify here that I do not have any

physical condition that limits my participation. Further, should physical limitation become necessary, I will notify the program director, in writing, with specifics.

↵ I understand that I will be doing rigorous academic work. I will report to class prepared with the necessary materials

(pens, pencil, textbooks, assignments, etc.).

↵ I understand I am required to dress according to the guidelines set for program functions. As a program focused on success and professionalism, sagging pants, revealing of underwear, cleavage, pants or skirts that are above the tip of my middle finger are not acceptable. UB staff reserves the right to identify other items that prove to be distractions.

↵ There is a time and place for cell phone and iPod (or other similar electronics) use; I will respect the boundaries of

usage set by Upward Bound staff

↵ I understand that I am responsible for my actions. I will only get out of Upward Bound what I put into the program.

↵ I understand that if I am involved in verbal or physical fighting, bullying (including cyber), or suspicion of drug or alcohol use - I may be released from Upward Bound.

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

_______________________________                _______________________________                    ___________________  Print Student’s Name Student Signature Date _______________________________                    ___________________ Parent/Guardian Signature Date

9

_______________________________                _______________________________                    ___________________  Print Student’s Name Student Signature Date _______________________________                    ___________________ Parent/Guardian Signature Date

Student Internet User Agreement University of Alaska Anchorage TRIO Upward Bound is pleased to offer students in the in the 2012 Summer Academy, access to the UAA computer network for Internet access. To obtain Internet access, all students must obtain parental permission and must sign and return this form to the Upward Bound office. Access to the Internet will enable students to explore thousands of libraries, databases, and bulletin boards while exchanging messages with Internet users throughout the world. Families should be aware that some material accessible via the Internet might contain items that are illegal, defamatory, inaccurate or potentially offensive. While our intent is to make Internet access available to further educational goals and objectives, students may find ways to access other materials as well. We believe that the benefits to students from access to the Internet, in the form of information resources and opportunities for collaboration, exceed any disadvantages. But ultimately, parents and guardians of minors are responsible for setting and conveying the standards that their children should follow when using media and information sources. Upward Bound Internet and E-mail Rights and Responsibilities Students are expected to act in a considerate and responsible manner when accessing network services. Students are responsible for good behavior on university computer networks just as they are in a classroom or a university hallway. Communications on the network are often public in nature. General Upward Bound expectations for behavior and communications apply. The network is provided for students to conduct research and communicate with others for the purposes of the Summer Academy. Parent permission is required and students who do not have such permission are responsible for not accessing the Internet while at UAA. Access is a privilege, not a right, and entails responsibility. Individual users of UAA computer networks are responsible for their behavior and communications over those networks. It is expected that users will comply with University of Alaska Anchorage’s and Upward Bounds standards and will honor the agreements they have signed. Network storage areas may be treated like school lockers. Network administrators may review files and communications to maintain system integrity and insure that users are using the system responsibly. Users should not expect that files stored on UAA servers would always be private. Within reason, freedom of speech and access to information will be honored. The following are not permitted: • Sending or displaying offensive messages or pictures • Using obscene language • Harassing, insulting, or attacking others • Violating copyright laws • Trespassing in another’s folders, work or files • Employing the network for commercial purposes • Deliberate damage to hardware or software • Use of UAA’s computers for illegal activities • Using another’s password Violation may result in a loss of access as well as other disciplinary or legal action.

Adopted language from Anchorage School District’s Student User Agreement

University of Alaska Anchorage Upward Bound Summer Application Form

3211 Providence Dr. | Rasmuson Hall, Room 106 | Anchorage, AK 99508 907.786.6124 or 907.786.4077 | success@uaa.alaska.edu

AGREEMENT TO RELEASE ALL CLAIMS FOR INJURY AND TO PROTECT

THE UNIVERSITY AND OTHERS FROM ANY SUCH CLAIMS THAT MAY BE BROUGHT (FOR MINOR PARTICIPANTS - AGE 17 AND YOUNGER)

THIS SECTION TO BE COMPLETED BY UA DEPARTMENT

Department Name: Faculty/Staff Contact Name:

Phone:

Name of Event:

Date(s):

List Activities: PRINT PARTICIPANT NAME____________________________________________________AGE________ My child, identified above, has chosen to be a participant in the above referenced Event. As his/her parent/legal guardian, I support my child’s decision to participate in this Event and, by signing below, indicate that I have reviewed the following information with my child and that we understand and agree to the information presented. I have made this choice in recognition and appreciation that there will be known and unknown risks, dangers and hazards which may be encountered in the above-mentioned Event. These risks, dangers and hazards include, among others, defective equipment which may break, be improperly adjusted, or be ill suited to my child’s abilities or physical size or condition; and inadequate or erroneous information about risks, faulty warnings or improper directions from the University personnel. I understand that these risks can cause permanent physical and mental injury or death (herein collectively referred to as “injury”). I also recognize that these consequences may be caused by the negligence or gross negligence (herein collectively referred to as “fault”) of the University of Alaska or fellow participants. With all of the above risks, dangers, hazards and consequences in mind, I DO HEREBY VOLUNTARILY ASSUME ALL RISKS, DANGERS AND HAZARDS that I or my child may encounter during participation in, and transportation to, from or as a part of, the Event. In addition, I declare that I intend that I, not the University, will be financially responsible for any injury that may occur to me or my child during or as a result of such participation or transportation, even if caused by the fault of the University. Further, in consideration of being permitted to participate, I hereby agree to release the University of Alaska, its board of regents, officers, agents, and employees, (Released Parties) from all liability and claims of any kind, including claims for loss, expense, damages, punitive damages or attorney fees, or loss of companionship or support of family, occurring during or as a result of participation in, or transportation to, from or as a part of this Event (Claims). This release applies even if such Claims are based on the fault of Released Parties. Further, I promise to indemnify and hold harmless the University of Alaska, and pay its costs of defense, if Claims are brought by me, my child, or anyone else against any of the Released Parties to recover money

damages related to injury to or death of me or my child. This promise applies even if the Claims are based on the negligence or gross negligence of the University or other related parties I understand that special personal accident insurance may be available to me, upon my request at my expense, through University of Alaska managed plans or otherwise, and that any obligation to purchase insurance is entirely mine. I have entered into this agreement on the basis of my own information and not in reliance upon representations of the University or other Released Parties. I understand that I have the right to consult an attorney of my choice before signing. I further understand that this document contains the entire agreement and no oral or written agreements limiting or modifying the effect of the terms of this agreement exist. I agree that if any part of this agreement is held to be invalid or unenforceable for any reasons, the balance of the agreement remains valid and enforceable. I intend that this agreement is and will be binding on my family, estate, heirs, successors, assigns, insurers, medical providers and personal representatives. By my signature, I represent that I have knowingly and voluntarily signed this agreement with the intent that it be a legally binding document designed to protect the University of Alaska and other Released Parties from all Claims which could be brought by myself or anyone else on account of injury to me or my child, regardless of cause or fault. ____________________________________________________________________________________ PARTICIPANT SIGNATURE DATE ADDRESS _______________________________________________ _________________________________________________________TELEPHONE _______________ In consideration of UA’s allowing the child to participate in the Event, the undersigned parent(s) or guardian agree on their own behalf, and on behalf of their child, to release UA from any claim the child, parent(s) or guardian may have because of injury or loss suffered by the child, including injury or loss claimed to be caused by the fault of UA. In addition, the parent(s) or guardian agree on their own behalf to protect and indemnify UA from any claim and related expenses and fees, brought at any time by the child or by anyone on the child’s behalf, or by any member of the child’s family, arising out of the child’s enrollment or participation in the activity. This indemnity includes Claims based on UA’s negligence or gross negligence. PRINT NAME: ______________________________________________ DATE: _______________________

(PARENT/LEGAL GUARDIAN)

SIGNATURE: _______________________________________________ DATE: _______________________ (PARENT/LEGAL GUARDIAN)

RB: 3-25-2008 DISTRIBUTION: Original - Department Copy - Participant

STUDENT ACCIDENT INSURANCE MAY BE AVAILABLE THROUGH RISK MANAGEMENT

UAA: 786-1351 UAF: 474-7889 UAS: 465-6496 SW: 450-8150