Application for Services

Application for Services

Veterans Upward Bound
Eligibility
In order to serve the most veterans, we have the following eligibility requirements:
- All participants must complete a VUB application to finalize enrollment.
- Any veteran with an academic need that VUB services can address may be enrolled our academic refresher classes. Prior participants may enroll a second time if there is space in the class(es).
Date of Application*

MonthDayYear
Date
I would like to request the following services:*
Personal Information
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Date
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Email
example@example.com
Preferred method of contact?
Emergency Contact*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Emergency Contact Relationship*

Education Information
What is your educational Status?*
HS/GED Graduation Year

MonthDayYear
Date
College/Technical School Information*
Degree/Certificate Awarded
Enrolled previously (Year)
Do you have a defaulted student loan?
What is your future education/career goal?*
After completing the Veterans Upward Bound Program, what are your education plans?*

Student Demographic Information
Completion of the following information is required for reporting and verification purposes.

Responses are kept confidential!
Employment*
Documented Disability*
Gender*
Marital Status*
Ethnicity*

American Indian/Alaskan NativeAsianBlack or African AmericanHispanic/LatinoWhiteNative Hawaiian or other Pacific Islander
Are you a Citizen, National or permanent resident of the United States?*
If "No" do any of these situations apply?
Has parent 1 graduated from college or university with a 4-year (baccalaureate) degree before your 18th birthday?*
Has parent 2 graduated from college or university with a 4-year (baccalaureate) degree before your 18th birthday?*

Student Demographic Information
Note:

When responding to the question below, “what is your total TAXABLE income for the last year” Please refer to the image below for guidance.

Line 15 on our tax return indicates your total taxable income. This is calculated by subtracting line 11 (your adjusted gross income) from line 14 (your standard deduction or itemized deductions and adding your qualified business income deduction if applicable).
Did you file a tax return last year?*
If Yes, what is your total TAXABLE income for last year (do not include any untaxed income):
The number of individuals currently living in your household and/or claimed as dependents (including yourself):*