Owens State Community College-VUB-Application Form

TRIO Veterans Upward Bound (VUB) Program Application
TRIO Veterans Upward Bound is a federally funded program through the US Department of Education. VUB assists veterans with enrollment, military educational benefits, and other resources to complete a post-secondary education.

*All services are provided free of charge to veterans who meet eligibility requirements*

PRINT CLEARLY - ineligible or incomplete applicans may be returned or rejected
Applicant Information
Name*

First NameMiddle InitialLast Name
Social Security #*
999-99-9999
Date of Birth

MonthDayYear
mm-dd-yyyy
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone*
(999)999-9999
Marital Status*

MarriedSeparatedSingleDivorcedWidowed
Emergency Contact

First NameLast Name
Phone
(999)999-9999
Relationship to Applicant
Participant Demographics
Employment*

UnemployedFull-timePart-timeRetired
Disability*

YesNo
Gender*

MaleFemale
Ethnicity*

HispanicNon-Hispanic
Race*

American Indian/Alaskan NativeBlack or African AmericanNative Hawaiian or Pacific IslanderAsianWhiteOther
Education
High School*

Not CompletedG.E.D. GraduateHigh School Graduate
College*

Associates DegreeBachelorsCertificates or Other
Have you been out of school for 5 or more years? (High school or post-secondary) (circle one)*

YesNo
What are your educational and career goals?*
Military Service History
Check All That Apply*

I served on active-duty for a period of more than 180 daysI served on active-duty and was discharged or released due to service-connected disabilityI was a member of a reserve component and was called to active-duty for a period of more than 30 daysI was a member of a reserve component and who served on active duty in support of a contingency operation on or after September 11, 2001
Branch of Service (Circle One)*

ArmyNavyAir ForceMarinesCoast Guard
Component (Circle One)*

Active-DutyReservesNational Guard
Nature of Discharge*
EAS/ETS Date*

MonthDayYear
mm-dd-yyyy
Military Education Benefits*

YesNoUnsure
First Generation Status
Did either parent/guardian hold a bachelor's degree prior to your 18th Birthday?
Mother/Female Guardian*

YesNoNot Applicable (Mother/Female Guardian was not present)
Father/Male Guardian*

YesNoNot Applicable (Father/Male Guardian was not present)
Income
Filing Status*

Select this option if you filed a tax return last year (2022)Select this option if you were not required to complete a tax return last year (2022)
The number of individuals living in my household or claimed as dependents was (including myself):*
Income Level*

Less than $21,870Less than $29,580Less than $37,290Less than $45,000Less than $52,710Less than $60,420Less than $68,130Less than $75,840More than $75,840
The number of individuals living in my household or claimed as dependents was (including myself):*
My total non-taxable income for last year was (from All Sources)*
$
Citizenship
Are you a citizen, national, or permanent resident of the United States*

YesNo
How did you hear about TRIO/Veterans Upward Bound*
By signing below, you are acknowledging the following:
I would like to participate in the TRIO/Veterans Upward Bound program.

I agree to adhere to all policies stated in the TRIO/Veterans Upward Bound information packet.

I understand and agree that failure to satisfactorily participate according to the TRIO/Veterans Upward Bound attendance policy can and will result in administrative withdrawal from the program.

I further understand and agree that TRIO/Veterans Upward Bound cannot benefit me without my full participation and cooperation in all activities.

I agree to achieve my program objective according to the individual education plan.

I hereby certify that the information provided in this application is accurate and complete to the best of my knowledge.
Veteran Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
DD-214 Your military discharge papers are officially known as DD Form 214, or just DD214. All veterans receive this Certificate of Release or Discharge from Active Duty once they are out of the military. If you have a copy of this form please upload it. If you do not have a copy our staff can help you secure a copy. ** PLEASE NOTE: This is not needed to submit your application for VUB

Cancelof
Applications can be returned to:

TRIO Veterans Upward Bound

Owens Community College

College Hall 140

30335 Oregon Rd.

Perrysburg, OH 43551

567.661.7300
Per the Family Educational Rights and Privacy Act (FERPA), information in this application CONFIDENTIAL – we will protect your sensitive personal data.

TRIO Veterans Upward Bound (VUB) Program Application

Applicant Information

Participant Demographics

Education

Military Service History

First Generation Status

Income

Citizenship

By signing below, you are acknowledging the following: