First Name *

Middle Name

Last Name *

Date of Birth *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Email *

Do you have a cell phone? *
- Select Option Yes No

Cell Phone Number *

From time to time, Grand Valley State University Veterans Upward Bound would like to send text messages, such as program updates and event invitations, to your phone. Carrier rates may apply.

Select to OPT OUT of Text Messages. To opt in, leave this section blank.
- Select Option Opt Out

Do you have a home/alternate phone? *
- Select Option Yes No

Alternate Phone Number *

Address Line 1 *

Address Line 2 (Apt. Number, etc.)

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

County *
- Select Option Allegan County Kent County Muskegon County Ottawa County Ionia County Kalamazoo County Calhoun County Not listed Please specify a value for County

Are you a U.S. Citizen?
- Select Option Yes No

Are you a Veteran?
- Select Option Yes No

Thank you for your interest. Only those meeting the eligibility requirements of military service for the program are eligible.

Type of Discharge *
- Select Option Honorable Other than Honorable General Dishonorable

Thank you for your interest. Only veterans with a discharge other than dishonorable are eligible for this program.

Eligibility Requirements (Check All That Apply) *
I have served at least 181 days of Active Duty.
I served on active duty and was discharged or released because of service-connected disability.
I was a member of a reserve component of the Armed Forces, called to Active Duty for a period of more than thirty (30) days.
I was a member of a reserve component of the Armed Forces who served on Active Duty in support of a contingency operation on or after September 11, 2001.

Felony Conviction/Pending Criminal Charges: Have you ever been convicted of a felony or have you been arrested for a crime for which criminal charges are pending? *
- Select Option Yes No

Thank you for disclosing. Answering YES does not necessarily disqualify you from participation in the program.

Do you have a documented service-related disability? *
- Select Option Yes No

Did either of your parents (that you live(d) with) receive a 4-year degree from a college/university BEFORE you were 18? *
- Select Option Yes No

Did you graduate from high school? *
- Select Option Yes No

What year did you graduate from High School? *
- 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Did you receive a GED certificate? *
- Select Option Yes No

What year did you receive your GED? *
- 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Have you received a Bachelors degree? *
- Select Option Yes No

Thank you for your interest. Only those without a four-year degree are eligible for the program.

Have you taken any college courses? *
- Select Option Yes No

Have you been out of school for 5 years or more? *
- Select Option Yes No

Have you taken the ALEKS assessment or any other placement assessments? *
- Select Option Yes No Unknown

If "yes," what score(s) did you receive?

The number of individuals living in my household and/or claimed as dependents (including myself) is... *
Please enter a value greater than or equal to 1.

Did you file taxes last year? *
- Select Option Yes No

How did you file? *
- Select Option Single Married Head of Household

My taxable income* for the last year was within the range of (select ONE response, please)... *
- Select Option $20,385 or less $20,386 -$27,465 $27,466 -$34,545 $34,546 -$41,625 $41,626 -$48,705 $48,706 -$55,785 $55,786 -$62,865 $62,866 -$69,945 $69,946 -$77,025 $77,026 -$84,105 $84,106 or more

Please specify your family's taxable income* here ONLY if your taxable income was $84,106 or more *

*Taxable Income: This information is located on tax forms (1040-line 43, 1040A-line 27, 1040EZ-line 6).
DO NOT USE YOUR ADJUSTED GROSS INCOME.

What type of service(s) can Veterans Upward Bound provide for you? (Check all that apply.) *
Admissions Application
Financial Aid Application
Scholarships
VA Education Benefits
Workforce Training
GED
Academic Advising
Career Exploration
College Transfer
Financial Literacy
ESL

If you need support with any services beyond those listed above, please list/describe them here.
Please enter at most 500 characters. You currently have:

The following information is required by the federal government for our grant. It will not be used as a basis for selection.

Gender *
- Select Option Male Female Other

Ethnicity (Check all that apply) *
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Other Pacific Islander
Hispanic or Latino
White
Not listed Please specify a value for Ethnicity (Check all that apply)

Have you participated in another TRIO Program during the last 12 months? *
- Select Option Yes No

In which TRIO Program did you participate? *

Are you currently employed? *
- Select Option Full Time Part Time Retired Unemployed

How did you find out about the VUB program? *
Community/Veterans Service Agency
Advertisement/Website/Print Material
VUB Present or Mentioned at an Event
Referral from another TRIO Program
Referral from a non-TRIO Program
Referral from Educational Institute
Social Media (Facebook, Instagram, Twitter, etc.)
Personal Referral (Friend/Relative, etc.)
VUB Staff
Not listed Please specify a value for How did you find out about the VUB program?

Check each box to certify the following: *
I certify that all of the information provided in this application is true and complete to the best of my knowledge.
I understand that the completion of this application does not guarantee acceptance into TRIO Veterans Upward Bound.
I understand that the completion of this application will be held in confidence by the TRIO Veterans Upward Bound program.
I understand that membership in Veterans Upward Bound is voluntary and that I may opt-out at any time without further obligation.
I understand that all information, services, and resources received through VUB are free.
I will connect with VUB staff a minimum of two (2) times a month during my membership (acceptable modes of communication/service include face to face, email, phone, workshops, events, text, etc.)
I will notify VUB if my address, phone number, or email address changes.

(Sign Below Using Touchscreen or Mouse)

Today's Date *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900