Veterans Upward Bound

Veterans Upward Bound
triovub@uco.edu
405-974-3635
https://blogs.uco.edu/ucostripes/
U.S. Department of Education - TRiO
Name*

First NameLast Name
Date of Birth

MonthDayYear
mm-dd-yyyy
Are you a U.S. Citizen/Permanent Resident?

YesNo
Gender

MaleFemale
Telephone
(999)999-9999
Can you receive texts at this number

YesNo
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OK County
Taxable Income

$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 - $79,080$79,081 +
Household/Family Size
Are you currently working?

YesNo
Race/Ethnicity (Check all that apply)

African AmericanAsianCaucasianHispanic/LatinoAmerican Indian/Native AlaskanNative Hawaiian/Pacific IslanderOther
What is your current military status? (Check all that apply):

Active DutyVeteranDisabled Veteran/Medically RetiredNational GuardReserves
If Active Duty, projected DOS
What is your highest level of education?

GEDHigh SchoolEnrolled nowSome CollegeUndergraduate DegreeGraduate Degree
What schools or areas of study interest you?
Have you been out of school more than five years?

YesNo
Do either of your parents have a Bachelor’s degree or higher?

YesNo

Read each item carefully. Using the scale shown below, please select the number that best describes YOU. 1= Definitely False 2=Mostly False 3=Somewhat False 4=Slightly False 5=Slightly True 6=Somewhat True 7=Mostly True 8=Definitely True

	Number
1. I can think of many ways to get out of a jam.
2. I energetically pursue my goals.
3. I feel tired most of the time.
4. There are lots of ways around any problem.
5. I am easily downed in an argument.
6. I can think of many ways to get things in life that are important to me.
7. I worry about my health.
8. Even when others get discouraged, I know I can find a way to solve the problem.
9. My past experiences have prepared me well for my future.
10. I've been pretty successful in life.
11. I usually find myself worrying about something.
12. I meet the goals that I set for myself.

I verify that the information that I provided is correct and give permission for the
STRIPES-VUB program to use this information to determine my eligibility for program services.

I give permission for the release of my official academic records and financial aid
information to the STRIPES-VUB staff to be used in needs assessments, program
planning, and reporting purposes.

I fully intend to enroll in a career technical school or college

***Please be advised. By signing the application, in the event of waitlisting of the TRIO Veteran's Upward Bound program, your application may be forwarded to TRIO Education Opportunities Centers (EOC) program to further assist you in obtaining expedient service in your educational endeavors.***
Signature

Clear
Date

MonthDayYear
mm-dd-yyyy