Thank you for your interest in our Veteran's Upward Bound program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (702) 774-4200.

General Information
Last Name *
First Name *
Middle Name
Address *
Address 2
City *
State *
Zip *
Phone
Cell Phone
Email Address *
NSHE ID Number (if applicable)
Social Security Number
Date of Birth *
Hispanic (1=Yes / 2=No) *
Asian (1=Yes / 2=No) *
Black or African American (1=Yes / 2=No) *
American Indian or Alaskan Native (1=Yes / 2=No) *
Native Hawaiian or Other Pacific Islander (1=Yes / 2=No) *
White (1=Yes / 2=No) *
Gender *
Citizenship *
Questions about your parents and about yourself:
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 answer the following question about yourself. 
Are you serving on active duty (for other than training purposes) in the U.S. Armed Forces? * *
Are you a U.S. Armed Forces veteran who was on active duty and was released under a condition other than dishonorable? *
Did you serve on active duty as a member of the Armed Forces of the United States for a period of more than 180 days and were you discharged or released under conditions other than dishonorable? *
Where you a member of a reserve component of the Armed Forces of the United States who was called to active duty for a period of more than 30 days? *
Were you a member of a reserve component of the Armed Forces of the Untied States who served on active duty in support of a contingency operation (as that term is defined in section 101(a)(13) of title 10, United States Code) on or after September 11, 2001? *
Are you homeless (i.e., you lack a fixed, regular, & adequate nighttime residence) or are at risk of becoming homeless?
You must answer the following questions about yourself if you answered YES to any question asked previously.
What is the total number of persons (including you) in your family unit?
My family’s taxable (not total) income from the last calendar year was: *
Most Recent IRS 1040

Determination of Applicant Need for Project Services

 
1. What branch of service did you serve? (CHECK ALL THAT APPLY)
Air Force
Navy
Army
Marines
Coastal Guard
National Guard
Reserves

2. Do you have a disability? (Service connected and/or non-service connected)
Do you have a Disability (0=Unknown / 1=Yes / 2=No)
VA Disability rating % (if applicable):

3. What is your current educational status in the U.S.A?

Educational Status *

4. Are you currently enrolled in college or at a vocational/technical institution (education beyond grade 12)?
Currently Enrolled *
If “YES”, please list the college(s) or institution(s).
If "No", I am interested in enrolling in (check all that apply):

5. Have you ever been enrolled in college or at a vocational/technical institution (education beyond grade 12)?  Please provide information for your most recent education.
Ever Enrolled *
If "Yes", please indicate college or institution.
GPA

6. I am interested in receiving information and/or assistance with applying for (check all that apply):
Admission
Financial Aid
College Degree (Either 2-Year or 4-Year)
GED / High School Diploma / High School Equivalency Certificate
Career and Academic Major Aligned With Life Goals

7. 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
If "Other", please indicate:

8. Have you completed a college entrance exam (i.e. ACT, SAT, Compass)?
Please select an option: *
If applicable, Date:
Score:

9. Have you been out of school for 5 years or more?

10. Indicate your main reason(s) for application into the program.
Need for refresher courses
Lack of career aspirations
Lack of preparation for postsecondary enrollment/continuation
Lack of confidence to transition into civilian life/postsecondary education
Lack of support
Lack of employable skills
Lack of awareness of student financial aid and/or military education benefits

11. How did you hear about us?
Recruitment
Other:

12. Employment Status:
Employment Status

Your VUB advisor/counselor will review your responses to the above questions and work with you to develop a plan that meets your academic needs. Please sign and submit.

Sign and Submit

By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of records to the Center for Academic Enrichment and Outreach (CAEO) at the University of Nevada, Las Vegas, understanding that the information in these records will be used only to assess the applicant's need for TRIO program services, discern the veteran's educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program-reporting requirements. Finally, I authorize CAEO to use the veteran's name, statements, and likeness, without charge, for promotional purposes in CAEO publications, advertising, video, and other formats. 
Signature: *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.