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Marcia Stuckey
Veterans Upward Bound Program Assistant
Scottsbluff Campus
stuckeym@wncc.net
308-635-6152

Veterans Upward Bound - WNCC
1601 E. 27th Street
Scottsbluff, NE 69361
308-635-6011
800-348-4435
vub@wncc.net



 

 
Veterans Upward Bound (VUB) Student Enrollment Form and
Veterans Contract with VUB
Where did you hear about the VUB Program:
Alliance Scottsbluff Sidney Rapid City, SD Torrington, WY
Last Name:
First Name:
Middle Initial:
Maiden Name:
SSN:
Date of Birth:
Gender:
Marital Status:

Personal Information:
Street Address:
City:
State:
Zip:
Permanent Phone :
Email Address :
Emergency Phone:
Alternate Phone:

Nearest Relative Information: Check here if
Relative's Name:
Relationship:
Street Address:
City:
State:
Zip:
Permanent Phone:
Work Phone:


For the following information, please select the appropriate response. all answers are confidential and reported as group data for program documentation purposes only:

Ethnic Origin:

American Indian/Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Native Hawaiian or Other Pacific Islander
More than one
Unknown

Eligibility:

Low Income AND First Generation
Low Income (ONLY)
First Generation (ONLY)
Unknown

Highest Grade Completed:
High School Drop-Out
High School Graduate
GED
High School + Some College Credits
GED/HS Equivalece + Some College Credits
Unknown
Employment Status:
Unemployed
Part-Time
Full-Time
Disabled
Retired
Will you transfer in any previous college credits?
Yes - If yes, How many hours (if known)?
No
Have you declared a current college major?
Yes - If yes, what major?
No
Dates of Military Service:
From: To:
What do you consider to be your academic need?
Math
English
Reading
Writing
Other - please specify:

ANNUAL LOW-INCOME LEVELS**
The term “low-income” means an individual whose family’s taxable income for the preceding year did not exceed 150% of the poverty level amount.

Size of Family Unit

Contiguous 48 States, the District of Columbia, & Outlying Jurisdictions

Alaska

Hawaii

1

$14,700.00

$18,375.00

$16,905.00

2

$19,800.00

$24,750.00

$22,770.00

3

$24,900.00

$31,125.00

$28,635.00

4

$30,000.00

$37,500.00

$34,500.00

5

$35,100.00

$43,875.00

$40,365.00

6

$40,200.00

$50,250.00

$46,230.00

7

$45,300.00

$56,625.00

$52,095.00

8

$50,400.00

$63,000.00

$57,960.00

For family units with more than 8 members, add the following amount for each additional family member:

  • $5,100.00 for the contiguous 48 states, the District of Columbia, and outlying jurisdictions
  • $6,375.00 for Alaska
  • $5,865.00 for Hawaii
Did either of your parents have a college degree while you were living in their household?
Yes
No
Have you completed a FAFSA (Federal Application for Student Aid)?
Yes - Which semesters are you approved for?
No
Are you eligible for GI Bill educational benefits and work-study?
Yes
No

STUDENT RESPONSIBILITIES FOR PROGRAM PARTICIPATION:

  • You will attend all scheduled classes and tutoring sessions. Records of attendance will be kept by the instructor and/or tutor.
  • Any materials or equipment checked-out is the responsibility of the veteran and a separate sign-out/sign-in sheet well be signed prior to lending any equipment or materials. If not returned the veteran will be ineligible for any further services from VUB.
  • The veteran must replace any property of the VUB program that is destroyed or lost in a reasonable amount of time. A contract will be developed t ensure that the item(s) are replaced.
  • Work-study veterans will be eligible for employment through the VUB office and will directly for the VUB Staff. Regular hours will be kept by any and all Work-Study personal.
    • Work-study absences must be cleared by the VUB staff.

This form must be completed and submitted to the WNCC VUB office PRIOR to your certificaion in order to insure eligibility for VA benefits.

CERTIFICATION ENROLLMENT

If this is your first enrollment at WNCC and/or the first time you have applied for Chapter 30, 31, 35 or 1606-07 benefits, you will need to fill out a 1990 form, which we will mail to the VA office in St. Louis. You are responsible for mailing your Member Copy 4 DD214 to St. Louis in order to receive your educational benefits.

It will take at least 6-8 weeks for your paperwork to be processed and for the VA to have your status reported and certified on the www.gibill.va.gov site or WAVE site. Do not call Veterans Upward Bound or check with us about your status until 6-8 weeks have passed since you applied for certification. Call 1-888-442-4551 and hit the 0 number to speak to a caseworker if you feel there is some error with your certification and it is taking longer than the 6-8 weeks. After that time please contact Louie Russ or Marcia Stuckey at the VUB office to assist you.

PAYMENT FOR ENROLLMENT

The VA will only pay for courses that apply to your stated degree program. YOU MUST CHECK WITH WNCC VUB STAFF FOR ENROLLMENT BEFORE THE END OF THE FREE DROP/ADD WEEK OR YOU MAY FIND YOURSELF IN CLASSES FOR WHICH YOU DO NOT RECEIVE PAYMENT. IF THIS OCCURS AFTER THE LAST DAY OF “DROP/ADD” THERE MAY BE NOTHING WE CAN DO TO HELP YOU. All courses must be approved by the Registrar for final approval as soon as possible. WE URGE YOU TO ENROLL PRIOR TO THE 10TH OF DECEMBER IF YOU WANT TO INSURE YOU WILL RECEIVE YOUR FIRST PAYMENT ON TIME FOR THE TWO WEEKS YOU ATTEND IN JANUARY. IF YOU COME IN FOR CERTIFICATION LATER THAN DECEMBER 10, YOU WILL POSSIBLY NOT APPEAR IN THE SYSTEM FOR 8-10 WEEKS AFTER THE START OF SECOND SEMESTER.

If you CHANGE YOUR PROGRAM OF STUDY you must fill out a 1995 form and have the credits you are enrolled in approved by the WNCC Registrar. This is especially true if you do this AFTER the start of the semester and AFTER the drop/add deadline has passed.

The VA will pay for you to retake a class if you fail it; however, this applies only to courses required for graduation. We will track your attendance in classes. The VA will not pay for classes in which you receive a “W”. Payments may be allowed if you submit mitigating circumstances to explain why you dropped or were dropped from the course. You may call the VA, but you must also submit a letter. Send a hand-written, signed letter as to why you withdrew or were dropped from the course. The address is: VA Regional Office, P.O. Box 66830, St. Louis, MO 63166-6830. To verify your enrollment you need to call 1-877-823-2378. Report accurately the number of hours in which you are enrolled.

OVERPAYMENTS

When overpayments occur, the VA will recover the money owed as soon as possible. Collection efforts are not limited to written requests for payment and withholding future benefits payments. Debts will be referred to a collection agency and the Department of Justice. Federal income tax refunds may be withheld and applied to VA debts. The overpayment can also affect your credit report. To avoid overpayments, call this office with ANY changes in your enrollment status.

PHONE OR USE THE WEBSITE WAVE AT THE END OF EACH MONTH TO ACCURATELY REPORT YOUR ENROLLMENT STATUS AND LAST DATE OF ATTENDANCE.

ADVANCED PAYMENT: Western Nebraska Community College does not participate in advanced payment of VA benefits.

Applicant Electronic Signature:

By submitting this application, I agree that the information contained within and all supporting documentation may be reviewed by WNCC VUB staff and/or its representatives. I also verify that I have read and understand the above requirements for WNCC VA Certification.

When you click "Preview My Enrollment Form", you will be presented with a draft of your application.

If you need to make changes, use your browser's "Back" button to return to this form.

If you are satisfied with the information contained within the Preview, click the Submit My Application button located at the bottom of the preview.






Please print a copy of your form after submitting.
 
Created/Maintained by WNCC MDC
Last Updated: March 29, 2006 10:17 AM