Step 1 of 5 20% Name First MI Last ctcLink IDDate of Birth MM slash DD slash YYYY PhoneEmail Do you want to receive text messages from the Veterans Resource Center (VRC) at the phone number entered above? Yes No How did you hear about the Veterans Resource Center? Bellevue College Department Bellevue College Website Community-Based Organization Flyer or Handout Classmate/Friend/Family Registered with VRC Before Other DemographicsAre you a veteran or family member of a veteran/service member? (spouse/child)*If active duty, guard, or reserve, please select “yes” for veteran Yes (Veteran) Yes (Family Member) No Are you a King County resident? Yes No Are you eligible for any VA education benefits? Yes No *MCAP funds are not available to veterans and dependents who are eligible for VA education benefits (GI Bill®, Dependents Education Assistance, etc.) If selecting “No”, you are affirming that you have verified with the Dept. of Veterans Affairs you are ineligible to receive any VA education benefits. If it is later determined you are eligible, you may be required to repay any funds received through the MCAP program.If you are eligible for any VA education benefits, which one(s)?Read each of the following statements and select ALL that apply to you (your responses are optional and will be kept confidential) Do you identify as Black, Indigenous, or a Person of Color (BIPOC)? Have you ever been incarcerated (served time in jail or prison)? Do you identify as a person with a disability? This includes physical, sensory, cognitive, mental health, or other conditions that may impact daily activities. Do you identify as part of the LGBTQ+ community? Household and IncomeNumber of People in Household (including spouse and/or children under 24)12345678910Net Monthly EarningsIncome after any taxes or deductionsYour Work EarningsSpouse/Partner's EarningsSocial Security BenefitsVeteran BenefitsAlimony ReceivedChild Support ReceivedOther IncomeTotal Monthly Net Income: Education History and GoalsHave you ever attended Bellevue College? Yes No Your Highest Education Level CompletedBelow High SchoolSome High SchoolGEDGraduated High SchoolLess than 45 College Credits45 College Credits or MoreCollege CertificateAssociate DegreeBachelors DegreeMasters Degree or HigherWhat Program of Study Interests You?It’s okay to write “undecided” if you are not sure – you can discuss options during your intake appointment.What is your desired enrollment level? Full-Time (12+ Credits) 3/4-Time (9-11 Credits) 1/2-Time (6-8 Credits) Less than 1/2-Time (1-5 Credits) Which resources were you interested in utilizing to help pay tuition costs? Military Community Assistance Program (MCAP) Funds Federal Financial Aid (FAFSA) Workforce Education Other What job would you like to have after completing your training at BC?Examples: nurse, software developer, business analyst, accountingPotential ChallengesWhich of these items might make it challenging for you to succeed in school or work? Select all that apply. Our staff may be able to refer you to school or community resources. Limited time to study No dedicated study space No reliable transportation Unstable living situation Financial planning/budgeting No reliable childcare or backup plan No supportive friends or family Health (mental and/or physical) No reliable computer/internet access Release of InformationI give permission for the Veterans Resource Center (VRC) and Bellevue College to use and share confidential information about me, as necessary, to the King County Veterans, Seniors and Human Services “Supporting Student Veterans and their Families” program. This consent is valid for a maximum of 2 years from the date signed, unless I withdraw or change my consent in writing. This consent DOES NOT permit sharing of sensitive information about my mental health, chemical dependency, HIV/AIDS Bellevue College adheres to FERPA regulations regarding the privacy of student information. The information you give us is confidential. Your signature authorizes us to release information to, and obtain information from, other Bellevue College departments and staff. I have read, understand, and agree to the Release of Information statement.Information True and Correct All information provided on this form is true and correct to the best of my knowledge. Electronic SignatureYou must provide your typed signature for this application to be valid. Please type your full name in the signature field below. Last Updated July 24, 2025
