Application Form: 2024-2025 BACI Upward College (after-school) Program

July 22, 2024—Indianapolis, IN, USA: The Burmese American Community Institute is pleased to announce the releasing of the application for the Upward College Program for academic year 2024-2025, a year-round program that assists area high school students with their college and career readiness and future success.

The Upward College Program helps prepare the participants their college and future success through its innovative and comprehensive curriculum design including tutoring (English, Math & Science, Social Sciences), training in Advanced English Writing, including Business & Technical Communications, Essay Writing, Reading, and Leadership Development, SAT/ACT Preparatory, College Admissions, FAFSA, Scholarship Applications, and provide college coaching and mentorship services. STEM (Science, Technology, Engineering and Mathematics) and Life Skill classes will also be included as well. The program will strictly implement health and safety measures that are in line with the federal and state suggestions in this midst of current pandemic. The program sessions/classes will officially kick-start on mid-August, 2024.

We are now full and only accepting Senior students. If you are not a senior, you will be waitlisted. Thank you

To apply, please complete the questions below

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Student ID Number *

Name *

First

Last

Date of Birth *

Gender *

• Female
• Male

Name of Your School *

Grade Level (currently) *

Career Interest (Nurse,business & etc..) *

GPA *

Your Phone Number *

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Your Student Email *

Your Address *

Address Line 1

City

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Zip Code

Ethnicity (Asian, Hispanic & etc..)

Student Primary Language

Student Limited English Proficiency *

• Yes - Limited English Proficiency
• No - Proficiency In English

Student Special Education Category *

• No - Not Special Ed.
• Yes - Special Ed.

Reduced Lunch Status (Free, Half, Paid)

Do you have your own transportation or would your parents be able to provide it? *

• Yes
• No

Student Have Medical Problem? *

• Yes
• No

Name of your health insurance company (If you do not have one, put none.) *

Health insurance policy holder *

Health insurance group number *

Student Medical Reason (Asthma/Allergic to Peanuts) *

Student Lives with *

Identifies the student as homeless? *

• Yes
• No

Homeless Unaccompanied Youth. *

• Yes
• No

Have you in the past or do you currently participating in BACI Upward College Program? *

• Yes
• No

If yes, which programs? *

• Summer 2024 UCP (Research Scholars/College Prep) Program
• UCP 2023-2024
• Summer 2023 UCP (Research Scholars/College Prep) Program
• UCP 2022-2023
• Summer 2022 UCP (Research Scholars/College Prep) Program
• UCP 2021-2022
• Summer 2021 UCP (Research Scholars/College Prep) Program
• UCP 2020-2021
• Summer 2020 UCP (Research Scholars/College Prep) Program

Do you intend to participate in the BACI program throughout your high school years?

• Yes
• No

Do you intend to participate in the BACI Giving Back to My Community Program during your college years? (Giving Back to My Community for BACI Alumni who will be expected to volunteer to assist Middle and High School students from their own community) *

• Yes
• No

Do you have siblings who are also applying to this program? *

• Yes
• No

If Yes, how many siblings are applying to the program and what are their names?

How did you hear about BACI Upward College Program? *

• Friend
• Current BACI UCP Participant
• Parent
• BACI Website
• BACI Facebook
• Other

Teacher's Information

Please fill your teacher's information as much as possible.

High School Math Teacher Full Name *

High School Math Teacher Email *

High School English Teacher Full Name *

High School English Teacher Email *

Parent Contact Information

Please make sure you fill this out correctly and with full information: Parent's information

What is your mother's or father's name? Contact 1 *

First

Last

Relationship with this contact (i.e mother, father, sister etc..) *

Contact 1 cell phone *

Work Phone & Employer

Email Address for Contact 1 *

Is contact 1 authorized to pick up students? *

• Yes
• No

Does student live with contact 1? *

• Yes
• No

Is contact 1 an Emergency Contact? *

• Yes
• No

Contact 1 Street Address and Zip code *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

What is Parent level of education?

• Did not finish high school
• High school diploma, no college
• Began college but did not complete
• Bachelors degree
• Masters degree or higher

Information Contact 2 (Parent 2 or other adult/elder relatives)

Name

First

Last

Relationship with this contact (i.e mother, father, sister etc..)

Phone Number

Email

Home phone / employer

Is contact 2 authorized to Pick Up students?

• Yes
• No

Does contact 2 lives with the student?

• Yes
• No

Is contact 2 an Emergency Contact?

• Yes
• No

What is Parent level of education?

• Did not finish high school
• High school diploma, no college
• Began college but did not complete
• Bachelors degree
• Masters degree or higher

Family USCIS Status

Are you a US Citizen or were you born here? *

• Yes
• No

Students and parents arrival status (refugees or asylee or I am a US born Citizen etc..) *

If you are refugee or asylee or such, what is your A# or I-94# or Green Card# *

US Arrival dates *

2023 Family Income *

Family Household Size *

Are you affiliated with any religion? What is the Name of it? (Church name, temple name, etc.)

Student’s signature (Full Name) *

Single Line Text

Submit

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