Wayne State University-VUB

Veterans Upward Bound – Client Application

Please submit a copy of your DD214 and picture ID with this application

As a grant recipient of the US Department of Education, Veterans Upward Bound (VUB) is committed to the guidelines provided under The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) which is a Federal law that protects the privacy of student education records. Veterans Upward Bound will not disclose your personal identifiable information to any third-party without your prior written consent.
- Name
  
  FirstMiddleLast
- SSN
  999-99-9999
- DOB
  
  MonthDayYear
  mm-dd-yyyy
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Home Phone
  (999)999-9999
- Cell Phone
  (999)999-9999
- Email Address
  example@example.com
- Emergency Contact Name
  
  First NameLast Name
- Emergency #
  (999)999-9999
- Gender
- Marital Status
- Race/Ethnicity (Select all that apply)
- Employment Status
- First Generation: Does either of your parents have a four year college degree?
- GI Benefits Eligibility
  
  Other
- Have you received services by another Federal TRIO program similar to VUB?
  
  Other
- What year?
- (Not eligible if you have received a bachelors’ degree.)
- High School Grade Level
- Highest Grade Completed
- High School
- Last Year Attended
- Post-Secondary Education (PSE)
- Have you ever attended a college or university?
- Last college attended:
- State
- Start Date
  
  MonthDayYear
  mm-dd-yyyy
- End Date
  
  MonthDayYear
  mm-dd-yyyy
- Do you have any degrees, certificates or credits earned?
- Year Earned:
- What are your PSE goals and objectives?
- Total household income for 2025
- Family Size (include self)
- Adj. Gross Income (Form 1040 Line 11a). TYPE $0 if your total income is from VA, social security, welfare benefits, disability income, retirement payments, workers comp or unemployment.
- Standard deduction amounts for 2025 –(Single, Married Filing Separately– $15,750), (Head of Household – $23,625); (Married Filing Jointly, Widower – $31,500); (Qualifying Surviving Spouse - $31,500)
- Total Taxable Income (Form 1040 Line 15 (Adjusted Gross Income (Minus) Standard Deduction)
- Do you receive disability benefits?
- What % ?
- Are the disability benefits...
- Type of Disability:
- Referred by (name/organization):
- How did you hear about us?
  
  Other
- Referral (name/organization)
- Recruitment Event (name/organization)
- Academic Need: (Select all that apply)
- Obstacles that may interfere with Class Attendance (Select all that apply)
  
  Other
- What is your field of Interest?
  
  Other
- As a VUB/VEOP client and student you are expected to: regularly attend the classes that have been scheduled for you, meet with your counselor for timely counseling and advising, and abide by the other regulations, as set forth by this office and explained by our staff. I commit myself to academic progress. I further agree to be counseled concerning my client/student responsibilities while I participate in the above program.
- Client/Student Photograph Release Statement (Optional)
- I hereby give my permission to the Veterans Upward Bound program to photograph, audio - and/or video tape, and/or interview me, and release such materials for the purposes of publication and/or promotion of VUB program. (This may include such events as class sessions, veterans’ day, graduation, open house, and others.) You may Opt out at any time I agree;
- Client/Student Text Message (Optional)
- I hereby give my written consent for Wayne State University Veterans Upward Bound to contact me regarding our educational programs and services using email, telephone or text – including our use of automated technology for periodic texts to the wireless number you provide. You may opt out at any time. I agree;
- I certify that the information on this form is true and accurate to the best of my knowledge. I also grant Veterans Upward Bound permission to obtain and review any academic documents needed to complete the application process and that is pertinent to my participation in the program. This may include certification of my prior and/or current school/college attendance.
- Clients/Student's Signature
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy
- Counselor Signature
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy
- I hereby, authorize the Veterans Upward Bound/VEOP at Wayne State University to obtain any records or data from my Secondary and/or post- secondary education files that is pertinent to my participation in the program. This may include certification or my prior education and/ or current school/ college attendance. (This information may be used to determine scholarship eligibility, provide statistical data, and for other VUB purposes.)
- Clients/Student's Signature
  
  Clear
- Date Signed
  
  MonthDayYear
  mm-dd-yyyy
- Please upload copies of the following documents (DD214 and Picture ID required):
- Copy of your DD214:
  
  Browse Files
  
  Cancelof
- Picture ID:
  
  Browse Files
  
  Cancelof
- Proof of Income for Last Year:
  
  Browse Files
  
  Cancelof