University Of Central Oklahoma-STARS-VUB-Application Form 2

405.974.3637 https://www.uco.edu/students/federal-programs/veterans-upward-bound

Personal Information
Name*

First NameLast Name
Gender*

FemaleMale
Phone *
(999)999-9999
Email*
example@example.com
Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth *

MonthDayYear
mm-dd-yyyy
Race / Ethnicity: (Check all that apply)*

American Indian/Alaskan NativeNative Hawaiian/Pacific IslanderAsianBlackHispanic/LatinoWhite

Educational Background
Do you have your high school diploma or GED?

YesNo
Are you enrolled in high school or a GED program?

YesNo
Name of High School/GED Program
High School Grade Level
Have you ever attended a college / technology center?

YesNo
Name of College/Technology Center
Do you have an associate’s degree or certificate?

YesNo
Have you ever participated in any of the following TRIO programs?

GEAR UPStudent Support ServicesTalent SearchUpward BoundUpward Bound Math and ScienceVeterans Upward BoundNO TRIO Background
What is your career interest?
Why is obtaining a college degree important to you?
What are your short-term goals?
What are your short-term goals?*

GED/HiSET CompletionApply for College/Career TechApply for Financial Aid/ScholarshipsGet a JobOther
What are your long-term goals?
What are your long-term goals?*

Apply for College/Career TechEnroll in College/Career TechObtain a Degree/CertificationApply for Financial Aid/ScholarshipsOther
Directions: Read each item carefully. Using the scale shown below, please select the number that best describes YOU and put that number in the blank provided.

1. = Definitely False 2. = Mostly False 3. = Somewhat False 4. = Slightly False
5. = Slightly True 6. = Somewhat True 7. = Mostly True 8. = Definitely True

Please select the number that best describes YOU

	Rating 1-8
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 the 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 VUB-STARS 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 VUB-STARS staff to be used in needs assessments, program planning, and reporting purposes. I fully intend to enroll in a technology center 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
Who referred you to the program?