University Of Southern Maine-VUB-Application Form

Taxable Income Range (required for all applicants) – Please check your taxable income range below:

NOTE: Do NOT use gross income, only income after all deductions. VA Compensation or Pension is not considered.

Tax Year: 2024 - forms 1040 and 1040-SR, line 15

Number of people in your family unit in 2022*

Family unit qty*

Taxable Income Range (Effective January 11, 2024, until furthernotice)*

The information I have provided is true and correct to the best of my knowledge. Completion of this application indicates my desire to participate and receive services and for program staff to obtain and utilize my personal information to assist me in reaching my educational goals.

I, {main_name}, certify that all the information regarding VETERAN STATUS, FIRST GENERATION and FINANCIAL ELIGIBLITY reported on the Veterans Upward Bound at USM’s application, is to the best of my knowledge and belief, true, correct and complete.

Signature*

Date*

mm-dd-yyyy

Veterans Upward Bound is hosted at the University of Southern Maine but serves veterans throughout the State of Maine and is 100% federally funded through the Department of Education at $297,601 annually. In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U. S.C. 552A), you are hereby notified that the Department of Education is authorized to collect information, including Social Security numbers (SSNs), to implement the Upward Bound program under Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102-325, sec. 402A and 402C). In accordance with this authority, the Department receives and maintains personal information on participants in the Upward Bound program. The principal purpose for collecting this information is to administer the program, including tracking and evaluating participants’ academic progress. Your SSN is collected only to serve as the unique identifier for matching participant records across years. Providing the information on this form, including a SSN, is voluntary; failure to disclose a SSN will not result in denial of any right, benefit, or privilege to which the participant is entitled. The information that is collected on this form will be retained in the program files and may be released to other Department officials in the performance of official duties. The information will not be disclosed outside of the Department, except as allowed by the Privacy Act of 1974, pursuant to the routine uses identified in the System of Records Notice titled “TRIO Programs Annual Performance Report (APR) System
(TRIO APR).

The University of Southern Maine is an EEP/AA employer, and does not discriminate on the grounds of race, color, religion, sex, sexual orientation, transgender status, gender expression, national origin, citizenship status, age, disability, genetic information or veteran's status in employment, education, and all other program activities. The following person has been designated to handle inquiries regarding non-discrimination policies. Director of Equal Opportunity, 101 North Stevens Hall, University of Maine, Orono, ME 04469 5754, 207-581-1226, TTY 711 (Maine Relay System).

Hosted by the University of Southern Maine