VUB Application

Personal Information

First Name *

Middle Name

Last Name *

Date of Birth *

Contact Information

Email *

Phone *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

County *

Eligibility

Citizenship Status *

Are you a Veteran? *

Type of Discharge *

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.

Have you ever been convicted of a felony or have you been arrested for a crime for which criminal charges are pending? *

Do you have a documented service-related disability? *

Income Verification

The number of individuals living in my household and/or claimed as dependents (including myself) is... *

Please specify your/your family's taxable income here *

Academic Need

Did either of your parents (that you live(d) with) receive a 4-year degree from a college/university BEFORE you were 18? *

Did you graduate from high school? *

Have you received a Bachelors degree? *

Have you been out of school for 5 years or more? *

Have you taken the ALEKS assessment or any other placement assessments? *

Services

If you need support with any services beyond those listed above, please list/describe them here. *

Demographic Information

Gender *

Ethnicity *
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or Other Pacific Islander
Hispanic or Latino
White
Multi-racial

Have you participated in another TRIO Program during the last 12 months? *

Are you currently employed? *

Acknowledgements

Signature *

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 and will not impact my G.I. Bill.
If accepted, as an active participant, 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.

Veterans Upward Bound

Welcome to TRIO Veterans Upward Bound

Office Location (GR)

Office Location (Battle Creek)

Contact Info