Apply for Veterans Upward Bound

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Step 1: Contact Information

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your best contact number?

(999)999-9999

What is your email address? *

example@example.com

Step 2: Personal History

What is your birthday?

Are you Hispanic or Latino?

What is your race?

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other

What is your gender?

Female
Male
Non-Binary
Prefer not to answer
Other

Are you a U.S. Citizen?

YES
No, but I am a Permanent Resident
No; I am not a U.S. citizen, and I am not a permanent resident

My Permanent Resident Alien number is:

Step 3: Family History

Has your mother received/earned a baccalaureate degree?

Has your father received/earned a baccalaureate degree?

Which parent did you regularly reside with and receive support from during your childhood (i.e., until you were 18 years old)?(Please check only one box.)

Both Mother and Father
Mother only
Father only
Neither Mother or Father

What is your current educational status in the U.S.A? (CHECK ONLY ONE)

High school dropout (1)
High school graduate (2)
GED/ high school equivalency credential recipient (3)
High school graduate with some college
Associate's Degree
Bachelor's Degree
Master's Degree
Unknown (0)

Are you currently enrolled in college or at a vocational/technical institution (education beyond grade 12)?

Has it been 5 or more years since you've been enrolled in college or at a vocational/Technical institution (education beyond grade 12)?

STEP 4: Household Information

Are you married?

Do you have children or other dependents (other than a spouse) who receives more than half of their support from you?

Are you homeless (i.e., you lack a fixed, regular, & adequate nighttime residence) or are at risk of becoming homeless?

STEP 5: Financial Information

To assist us in determining your eligibility, please complete the following section required by the Department of Education. The information that you provide is protected by the Family Rights and Privacy Act and therefore, will be kept confidential and on file at the Veterans Upward Bound of DC Program office located at The Catholic University of America.

What best describes your employment status?

Not currently working
Employed part time
Employed full time

Please select source of income: (Check ALL that apply)

Salary/ Wages
Public Assistance (welfare)
Unemployment Compensation
Social Security

Do you meet the income requirement as defined below?

Yes
No
I don't know

"Low income" for this program is defined by 150% of the federal poverty level, subject to family size and dependents. In 2024, that is $21,870 for a 1 person household, $29,580 for a 2 person household, $37,290 for a 3 person household, $45,000 for a 4 person household, etc. Income is ONLY what is taxable - this does not include disability payments, social security payments, etc. If you have any questions, simply select "I don't know" and we will help you determine it.

Total number of people residing in your household:

1
2
3
4
5
6
7
8 or more

Date / Time

STEP 6: Military History

Name *

First

Middle

Last

What branch of service did you serve? (CHECK ALL THAT APPLY)

Air Force
Marines
Coastal Guard
Reserves
Army
Navy
National Guard

Do you have a service connected disability?

% Disability Rating

I am interested in receiving information and/or assistance with applying for (check all that apply):

Admission (including transfer assistance) to a college or vocational/ technical institution (education beyond grade 12)
Financial aid that can help me pay the cost of attending a college or vocational/ technical institution (education beyond grade 12)
College Degree (either 2-year or 4-year)
GED/ High School Diploma/ High School Equivalency Certificate
Career and Academic Major Aligned with Life Goals

Please select the desired courses you would like to take while in the program. (Select all that apply)

Math
English
Computer Literacy
Financial Literacy
Other

Have you completed a college entrance exam (i.e. ACT, SAT, Compass)?

Active Duty Start Date:

Discharge Date (if applicable):

Please check if you are still:

Serving active duty
In reserves

Do you meet the definition of the term Veteran per the description below?

The definition of the term Veteran for the purposes of this program is someone who meets ANY of the following statements: (a) served in active duty in the U.S. Armed Forces for more than 180 days and received other than a dishonorable discharge (b) was discharged because of a service-connected disability (c) was a member of a reserve component of the Armed Forces called to active duty for more than 30 days (d) or was a member of a reserve component of the Armed Forces who served on active duty in support of a contingency operation on or after September 11, 2001 (e) have a high risk for academic failure

Signature

By signing this application, I attest that all the information on this application is correct and true. Moreover, I authorize the release of my academic records to the Veterans Upward Bound of DC (VUB DC) program hosted at The Catholic University of America, Washington, DC, understanding that the information in these record will be used only to assess the applicant's need for TRIO program services, discerning the veteran's educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program reporting requirements. Finally, I authorize VUB DC to use the veteran's name, statements and likeness, without charge, for promotional purposes in VUB DC publications, advertising, video, and other formats.

Signature