Redlands Community College-VUB-2023 Application Form

VUBRCC Form
Veterans Upward Bound is a cost free federally-funded program through the U.S. Department of Education program designed to assist veterans in the development of the required skills needed to succeed in college or VoTech program of your choice.

If you have any questions give us a call at 405.422.1405 or vub@redlandscc.edu or any of VUB's Academic Advisors:
- Michael Lummus at 405.422.1455 or email him at michael.lummus@redlandscc.edu
- Karen White Bouziden a call at 405.422.1484 or email her at karen.whitebouziden@redlandscc.edu

Veteran's Participant Information
Name*

First NameMILast Name
Birth Date*

MonthDayYear
mm-dd-yyyy
Sex*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Phone Number: Cell*
(999)999-9999
E-mail*
example@example.com
Referred to VUB by:

Income Statement
What is your current employment status?*
What is Your Current Income*
What is Your Taxable Income*
Number in household (include yourself)*

If you have not filed and/or will not file or do not have access to your U. S. Income Tax return (1040, 1040A, 1040EZ, etc.) for the most recent required filing period, please list all household income you and your spouse received which would have been reported on that return. (example: Current Employment, Military Retirement, VA Disability Compensation, and/or Social Security Benefit Payments)*

	Source of Income	Yearly Amount	Taxable Y/N
Source 1
Source 2
Source 3
Source 4

Signatures
I attest that I am the applicant making this application to the U.S. Department of Education grant funded Veterans Upward Bound Program, and that all of the above information I have provided is true, complete, and accurate to the best of my knowledge and belief. I understand that any omission, inaccuracy, or failure to make full disclosure may be deemed sufficiently by the Veterans Upward Bound Program Director to deny continued participation in the Veterans Upward Bound program. (CFR 34 645.3; 645.4 (b); 645.6)
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
MISSION STATEMENT: Veterans Upward Bound is designed to motivate and assist veterans in the development of academic and other requisite skills necessary for acceptance and success in a program of postsecondary education. Redlands Community College's mission is to foster a learning environment in which students, faculty, staff and community interact to educate students for life. IN COMPLIANCE with Title VI of the Civil Rights Act of 1967, Executive order 11246 as amended, Title IX of the Education Amendments of 1972, sections 503 and 504 of the Rehabilitation Act of 1973, and other Federal Laws and Regulations, Redlands Community College does not discriminate on the basis of race, color, national origin, sex, age, religion, handicap, disability, or status as a veteran in any of its policies, practices or procedures. This includes, but is not limited to admissions, employment, financial aid, and educational services. This program is fully funded by the US Dept. of Education; 2017 grant award totaled $297,601.00.

VUBRCC Form