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?*
Did you file a tax return last year?*
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):*