EKU Veterans Upward Bound Application

Veteran Information

First Name

Last Name

Birthdate

Email Address

Phone Number

County of Residence

Demographic Information

Gender

Male

Female

I choose not to identify at this time

Please Specify:

Are you a US Citizen or Permanent Resident?

Yes

Employment Status

Unemployed

Retired

Employed Part Time

Employed Full Time

Please check the box that most closely describes you:

I did not complete High School or my GED.

I graduated from High School or completed my GED, but never attended College or University.

I am currently attending College or University

I Attended College or University *more* than 5 years ago, but did not graduate.

I Attended College or University *less* than 5 years ago, but did not graduate.

I hold a 2 year degree such as an Associate degree.

I hold a 4-year degree such a a Bachelor degree.

I hold a post-baccalaureate degree, such as a Master's or Doctorate.

Are you a first-generation college student*
*Neither parent received a 4-year degree prior to you turning 18

Do you have a disability?

Yes

Pending

Household Information

Number of people living in household (enter "1" if only yourself)

Taxable Household Income (1040-line 43, 1040A-line 27, 1040EZ-line 6)*:

*Do not include untaxed income such as VA benefits, Housing Allowances, or other military-related payments.

Service Details

Are you a Veteran?

(Have you served in the United States Military to include Active Duty, Reserves, and Guard?)

Branch of Service

Did you receive a discharge other than dishonorable?

Self-Assessment

This section will help us determine how our program can best help you!

What educational goal(s) will VUB help you to achieve? (Check all that apply)

Other:

Preferred Learning Style:

Visual

Auditory

Hands-on

Reading/Writing

Please indicate below how knowledgeable you feel about the following categories:

Academic Subjects (English, Math, Science, etc.)

1- Little to No Knowledge

2- Basic Understanding only

3- Well Informed

Academic Subjects (English, Math, Science, etc.)

Veteran Education Benefits

1- Little to No Knowledge

2- Basic Understanding only

3- Well Informed

Veteran Education Benefits

Local Veteran Support Services

1- Little to No Knowledge

2- Basic Understanding only

3- Well Informed

Local Veteran Support Services

Achieving my Goals

1- Little to No Knowledge

2- Basic Understanding only

3- Well Informed

Achieving my Goals

Confirm Application Submission
I understand that withholding information requested on this application or giving false information may make me ineligible for admission to the Veterans Upward Bound Program or subject to dismissal. I have read this application and certify that the statements I have made on this application are correct and complete.

By electronic submission of this application, I acknowledge that I am bound by the same legal and academic standards as a signed application for admission. I understand that withholding information or giving false information will make me ineligible for admission.

In place of your signature, please type your full legal name:

Signature: