ASU TRIO Veterans Upward Bound Application

NEW STUDENT APPLICATION

Thank you for your interest in ASU TRIO Veterans Upward Bound.

Please complete this new student application as thoroughly as possible as you cannot save and restart this application. We recommend reviewing the application questions including links and then returning to this application once you have collected the necessary information. If you have any questions, please call our office at 480.965.6483 or email us at triovub@asu.edu.

Items listed with (*) are required fields.

Veteran Information:

First Name *

Last Name *

Middle Name

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Email Address *

Phone *

Check box to receive text messages at phone number above.

Citizenship Status *

Employment Status *

Date of Birth *

Gender *

Title

Preferred Pronouns

Race/Ethnicity: (please check all that apply)

African American/Black

American Indian/Alaskan Native

Asian

Caucasian/White

Hispanic

Native Hawaiian or Other Pacific Islander

Military Service:

Military Branch of Service *

Type of Discharge: *

Description of active duty service: *

Please upload a "long-form" DD214 copy (Service 2 or Member 4 copies ONLY)

Are you a person with a documented disability? (please check all that apply)

Yes, Military Connected

Yes, Learning Disability

Yes, Other

Academic Information:

Are you a former participant of any TRIO programs?

What is your highest education level? *

As of today, have you been out of school for five or more years? *

As of today, are you enrolled in a certificate program, technical/ vocational school, jr/community college, or university? *

If Yes, enter name of institution:

If Yes, enter start date of course(s) MM/DD/YYYY:

What type of military educational benefits have you used in the past? *

What is your future education/career goal? *

Please indicate your program needs with the checkboxes below (select all that apply):*

Personal

Becoming more involved on campus

Concerned about transitioning to civilian life

Afraid of failing in college

Difficulty meeting new people

May benefit from personal counseling

Difficulty participating in discussions

Problems at home

Limited and/or no support from family/friends

Academic

Improve writing skills (spelling, grammar, and vocabulary)

Increase reading comprehension, reading speed, memory

Improve math skills and/or reduce math anxiety

Improve study habits (note-taking skills, time management)

Financial

Need assistance completing my military education benefits

Financial concerns

Difficulty budgeting money

Being aware of student financial aid resources

Well being

Health concerns

Concerns with maintaining physical health

Other

Unsure about college procedures

Gaining employable skills

Exploring career aspirations

Limited computer and/or internet skills

Family Information:

How many people are in your family including yourself? *

What is your family’s taxable income?

VA Benefits, Social Security Benefits, and/or GI Bill Benefits are NOT considered taxable income. Please do not include any of those amounts above.

If available, please enter the dollar amount on Line 15 of your family's most recent 1040 federal tax form.

Click to view Federal TRIO Programs Current-Year Low-Income Levels.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Parent(s) Education:

Prior to your 18th birthday, did your mother earn a baccalaureate (bachelor's) degree? *

Prior to your 18th birthday, did your father earn a baccalaureate (bachelor's) degree?

How did you hear about ASU TRIO Veterans Upward Bound? *

The information provided on this application will be used to communicate with students and families about Arizona State University events and enrollment.

I understand and accept the conditions listed above: *

I am interested in receiving information about ASU Family Hub.

I am interested in receiving information about ASU Family Hub: *

Student Agreement and Signature:

I agree that if I am accepted into ASU TRIO Veterans Upward Bound, I pledge to:

Attend all meetings, advising sessions, tutoring sessions, activities and/or field trips, both in-person and virtual.
Be an active participant in ASU TRIO Veterans Upward Bound until I successfully complete the program.
Attend classes regularly and work to maintain a passing grade.
Attend tutoring if I receive a grade C or lower in any of my academic refresher courses.
Cooperate and behave in a mature, responsible way with ASU TRIO Veterans Upward Bound staff and students as well as follow the ABOR Student Code of Conduct.
Enter a postsecondary educational program upon completion of ASU TRIO Veterans Upward Bound.
Provide follow-up information to ASU TRIO Veterans Upward Bound concerning my success in obtaining a postsecondary degree.

In addition,

I understand that I will participate in Arizona State University (ASU) TRIO Veterans Upward Bound and receive the services provided in person or virtually. (Examples: myASU, Canvas, Zoom, PhotoStudy by Got it, Google Suite, MS Suite)
I understand that I will participate in group activities, field trips, and one-to-one sessions with staff.
I authorize ASU TRIO Veterans Upward Bound to obtain information related to my application for college admission and acceptance status, financial aid applications (FAFSA and scholarships), and award letter to any and all colleges and universities.
I give consent for my information, including my name, picture, graduate status, college, major and any awards or scholarships that I receive to be used by ASU TRIO Veterans Upward Bound in publications or ASU display cases to promote the success of TRIO students.

By signing my name, I acknowledge that participation in all ASU TRIO Veterans Upward Bound activities is vital to my success. I agree to follow the above rules and understand that violation of these rules may result in dismissal from the program. I certify that each response within this application is true and complete to the best of my knowledge. I acknowledge and give consent to the requests of ASU TRIO Veterans Upward Bound.

Student Signature *

Please select a signature verification type.

ASU TRIO Veterans Upward Bound is a federally funded college access and success program sponsored by the U.S. Department of Education preparing first-generation college bound veteran students to enter and succeed in higher education. Click here to learn more.

Privacy Act: In accordance with the Privacy Act of 1974 (Public Law 93-579, 5 U.S.C. 552a), you are hereby notified that the U.S. Department of Education is authorized to college information to implement the Veterans Upward Bound program under Title IV of the Higher Education Act of 1965, as amended (Public Law 102-325, Sec. 402c). In accordance with this authority, the Department receives and maintains personal information on participants in the Veterans Upward Bound program. The principle purpose for collecting this information is to administer the program, including tracking and evaluating participants' academic progress. The information that is collected on this application will be retained in the program files and may be released to other Department officials in the performance of official duties.