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Veterans Upward Bound
Apply Online
Apply Online
Veteran’s Upward Bound Application
Name
(Required)
First
Middle
Last
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone Number
(Required)
Email Address
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Please select below
Male
Female
Other
Ethnicity
(Required)
Please select below
White/Caucasian
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Pacific Islander
American Indian/Alaskan Native
How did you hear about the Veteran's Upward Bound Program?
(Required)
Are you a U.S. citizen?
(Required)
Yes
No
If not a U.S. citizen, please enter Alien Registration #
Employment
(Required)
Please select below
Unemployed
Part-time
Full-time
Retired
Projected TAXABLE Net Income (not Gross) for the current calendar year. Do not include Disability Income, Alimony, Overseas Pay, Housing Allowance or Child Support
(Required)
Please select below
$0-$21,870
$21,871-$29,580
$29,581-$37,290
$37,291-$45,000
$45,001-$52,710
$52,711-$60,420
$60,421-$68,130
$68,131-$75,840
$75,841-$83,550
$83,551-$91,260
$91,261+
Number in your Household (you and any dependents)
(Required)
Branch of Service
(Required)
Please select below
Army
Navy
USMC
Air Force
Space Force
Coast Guard
Army Reserves
Navy Reserves
USMC Reserves
Air Force Reserves
Coast Guard Reserves
Army National Guard
Air National Guard
Date of Discharge
(Required)
Do you have a current VA Disability Rating?
(Required)
Yes
No
Disability Rating
Type of Discharge
(Required)
Honorable
General
Bad Conduct
Dishonorable
Other than Honorable
Other
High School Education
(Required)
High School Graduate
GED
Highest level of education
(Required)
Please select below
GED
High School Diploma
Some College
Associate
Bachelor
Beyond
Have you been out of school for 5 years or more?
(Required)
Yes
No
If no, are you currently in school?
Yes
No
Did your parent(s), natural or adoptive, graduate with a bachelors degree prior to you turning 18?
(Required)
Yes
No
Which Veterans Upward Bound services are you interested in? (check all that apply)
(Required)
Assessment of academic skills
Academic refresher courses
Development of an education/career plan
GED Completion
Assistance with Financial Aid and veterans’ benefits applications
Community/veterans’ agencies and supportive services referrals
Assessment of career interests
Assistance w/ post-secondary school applications
Information about college degree plans and programs
After completing the Veterans Upward Bound program, what are your educational plans?
(Required)
GED only (no school after VUB)
Community College/Vocational/Technical School
College/University
If you are planning on continuing your education what degree and/or course of study/program are you interested in?
Release of Information
I understand that by applying to participate in the VUB Program, I authorize VUB Program staff to obtain records of data pertinent to my VUB participation from other sources as identified and to release information to the United States Department of Education as mandated. The VUB Program staff also has my permission to communicate verbally or otherwise (email, cell phone, texting, etc) with myself, staff, faculty, and/or off-campus professionals on my behalf as identified below. I understand that all information will be kept confidential and that records will be used for documenting eligibility for the program and for reporting purposes. Unless written permission is given by you, the student, information maintained in your file will remain confidential and will not be released to a third party or agency. The only exception to this rule is in the clear instance of a legal duty to warn or report, or if your file is legally court ordered. Please discuss any questions concerning “legal duty” or “court ordered” with program staff prior to signing this form.
Release To/Request From
Admissions
High School/College/Military Transcript Requests
Testing Center (COMPASS, ACT, SAT Results)
Nation Student Clearinghouse – (Confirmation of post-secondary enrollment status. This authorization remains in effect for six years following enrollment in a post-secondary program.)
VA: Medical Center/Vet Success
First semester class schedule in post-secondary program. Enrollment in non-credit classes.
Photo Release Statement
(Required)
Do you consent to having your photo used for VUB program resources and materials? This may include use in marketing materials, websites, and/or social media.
Yes
No
Please upload a photo of yourself if possible
Max. file size: 10 MB.
Certification and Approval
I certify that the information provided in the application is accurate and complete. I agree VUB can use my image in their student database for identification purposes. I agree to use VUB computers for VUB activities only. Use of printer, copier, or fax equipment must be approved by VUB staff.
Signature of the Applicant (Type your name here)
(Required)
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