231713-North Alabama Center For Educational Excell-VUB-Application Form-Shaun

If this question does not apply to you, please put N/A in the response box.
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VETERANS UPWARD BOUND APPLICATION
- Name*
  
  First NameLast Name
- Social Security Number*
  999-99-9999
- Date of birth*
  
  MonthDayYear
  mm-dd-yyyy
- Current Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Email Address*
  example@example.com
- Phone Number*
  (999)999-9999
- Other Phone Number*
  (999)999-9999
- Are you a U.S. Citizen?*
  
  YesNo
- If no, Alien Registration #*
- Are you disabled?*
  
  YesNo
- Gender*
  
  MaleFemale
- Marital Status*
  
  SingleMarriedDivorcedSeparatedWidowed
- Ethnicity*
  
  White/CaucasianNative American/AlaskanAsianNative Hawaiian/Pacific IslanderBlack/African AmericanMulti-RacialHispanic/LatinoOther
- High School and College Information (Check all that apply)*
  
  H.S. GraduateGED GraduateCurrently in CollegeH.S. DropoutAssociate's DegreeBachelor's DegreeNon-Degree SeekingCollege Dropout
- If Currently in College, (select yr completed)*
  
  FreshmanSophomoreJuniorSenior
- College/Technical School: Enrolled in a college/vo-tech program?*
  
  Never enrolledEnrolled in the pastCurrently Enrolled
- Name(s) of college(s)/vo-tech(s) attended*
- Dates attended*
- Credit hours earned*
- GPA*
- College You Are Planning to Attend*
- Entrance Date*
- Major *
- Been Out of School For 5 Years*
  
  YesNo
- Did either of your parents graduate from a 4 year university?*
  
  YesNo
- If yes, from where?*
- DD-214 File Upload
  
  Browse Files
  
  Cancelof
- Branch of Service*
- Type of Discharge*
  
  HonorableGeneralOther than honorableDishonorableOther
- Select one*
  
  Served on a reserve component and was called to active duty for more than 30 days.Served on active duty and was released or discharged with a service connected disability.Served on active duty in a reserve component in support of a contingency operation on or after 9/11/2001.Served more than 180 days on active duty and was discharged under conditions other than dishonorable.None of the above
- Are you a combat veteran? *
  
  YesNo
- If yes, which one?*
- Length of Active Duty*
- Employment Status*
  
  Full-TimePart-TimeUnemployedRetired
- Dependent Status (as claimed on tax return)*
  
  SelfSpouse# of children
- 2023 Taxable Income.... DO NOT USE ADJUSTED GROSS INCOME for this report.*
  
  $0 - $22,590$22,591 - $30,660$30,661 - $38,730$38,731 - $46,800$46,801 - $54,870$54,871 - $62,940$62,941 - $71,010$71,011 - $79,080Other
- Please upload your Tax Documentation
  
  Browse Files
  
  Cancelof
- How did you hear about the Veterans Upward Bound Program?*
  
  VUB LetterOther ParticipantsEmployment OfficeOur websiteFlyer or BookmarksRadioV.A.Walk-inCollege OfficeOther
- What Veterans Upward Bound Services are you most interested in?*
  
  Assessment of academic skillsDevelopment of an education or career planInformation about college degree plans and programsAssistance with Financial Aid and veterans' benefits applicationsBasic Skills DevelopmentAssessment of career interestsAssistance with postsecondary school applicationsCultural and social opportunitiesStudy SkillsCollege visits/toursReferral to community/veterans'agencies and local support servicesSpecial Services (Math/Science Support)Short term academic refresher courses
- If answered Short term academic refresher courses, please check all that apply*
  
  MathematicsScienceForeign LanguageWritingLiteratureReadingComputer Skills
- I declare that all information on this application is true to the best of my knowledge. The North Alabama Center for Educational Excellence's Veterans Upward Bound Program and the Department of Education have my permission to verify this information. I agree to furnish additional documentation as needed as a condition of my participation in VUB. I understand the submission of untrue information can result in my termination from the program.
  
  My signature below indicates, to the best of my knowledge, that the information provided on all forms of this application packet (IDS, IEP, and contact sheet(s)) are true, complete, and accurate. I hereby authorize the North Alabama Center for Educational Excellence staff to obtain copies of my academic and financial assistance records from the educational institution I am now attending and from the educational institutions I will attend in the future.
  
  By signing this form, I also agree that it is my responsibility to return all books and /or equipment loaned to me for my success in this program in a timely manner.
- Client Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Counselor/Advisor Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy

VETERANS UPWARD BOUND APPLICATION