Has either parent graduated from a college or university with a 4-year (baccalaureate) degree?

Complete this item only if you filed a tax return last year

Complete this item only if you DID NOT file a tax return last year

Completion of the following is required for reporting and verification purposes. Responses are kept confidential!

What VUB services are you most interested in? (Check all that apply)

Math / Writing Pretest: Please complete at least one of the following short pre-tests.

• Math Pre-Test: https://bit.ly/kuvubmathpre
• Reading Pre-Test: https://bit.ly/kuvubreadingpre

I would like to participate in Veterans Upward Bound and receive the free services provided. I hereby certify that the information provided in this application is accurate and complete to the best of my knowledge.

The University of Kansas Veterans Upward Bound, under the U.S. Department of Education, is authorized and required to maintain an information file on program participants (Public Law 102-325, sec. 402c). The personal information you give to Veterans Upward Bound program staff will be used to determine your eligibility for this program, establish eligibility for other programs/ benefits you may be entitled to, and to identify needs and ongoing concerns.

As required by law, the program is also responsible for tracking academic performance of our participants until graduation from a college or training program. Student records are kept for a period of eight years after your last date of VUB service, and academic tracking records are maintained as long as you are pursuing training.

Information to be released to/or received from veterans servicing agencies, post-secondary institutions, and the National Student Clearinghouse includes, but is not limited to, the following:

• Academic records
• Transcripts
• Financial aid and GI Bill information
• Test scores
• Grade summaries
• Other educational records
• DD214
• Employment records
• Diagnostic reports
• Income information
• Career and job interest assessments
   

1. I hereby authorize the Veterans Upward Bound program to receive copies of all of my academic records and transcripts until my graduation from a college or a vocational training program.
2. I hereby authorize the Veterans Upward Bound program to access my financial aid, educational, academic assessment, or vocational rehabilitation information related to my participation in this program.

I have read and agree with the Veterans Upward Bound confidentiality and release of information policies.

Privacy Act Statement

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).”