University of Vermont

Student Employment Office

Student Employment Request to Participate Form

Off Campus Agency Request to Participate

Request Form

Thank you for your interest in the Federal Work Study Program. Each year we send over 50 students into the community to earn their Federal Work Study funds. By filling out the form below you are informing the Federal Work Study Coordinator of your interest in program.

This form will need to be filled out by each member of your staff who is interested in supervising a UVM student employee.

Contact Information

*Required Fields

*First Name   *Last Name

*Date of Birth (ie: mm/dd/yyyy used to identify you as a unique registrant)

*Agency Name (no acronyms please) *Agency Department

*Billing Address   *City   *State   *Zip

*e-Mail   *Contact Phone

Request to schedule a meeting with the Federal Work Study Coordinator

Please indicate if you would like to meet with the Federal Work Study Coordinator:


Equal Employment Opportunity/Affirmative Action Policy

The University of Vermont and State Agricultural College is committed to a policy of equal employment opportunity and to a program of affirmative action in order to fulfill that policy. The University will accordingly recruit and hire into all positions the most qualified persons in light of job-related requirements, and applicants and employees shall be treated in employment matters without regard to unlawful criteria including race, color, religion, ancestry, national origin, place of birth, sex, sexual orientation, disability, age, positive HIV-related blood test results, status as a disabled or Vietnam Era Veteran, genetic information, or gender identity or expression, as these terms are defined under applicable law, or any other factor or characteristic protected by law. In addition, the University of Vermont recognizes that discriminatory harassment and sexual harassment are forms of unlawful discrimination, and it is, therefore, the policy of the University that discriminatory harassment and sexual harassment will not be tolerated. The University also prohibits unlawful harassment on the basis of other characteristics protected by law. Further, employees and applicants will not be subjected to harassment or retaliation because they have engaged in or may engage in the following: filing a complaint or assisting or participating in an investigation regarding alleged discrimination or harassment as prohibited in the policy statement above; filing a complaint or assisting or participating in an investigation, compliance evaluation, or any other activity related to the administration of the Vietnam Era Veterans' Readjustment Assistance Act of 1974 ("VEVRAA"), Section 503 of the Rehabilitation Act of 1973 ("Rehabilitation Act"), or the Affirmative Action provisions of federal, state or local law; opposing any act or practice made unlawful by VEVRAA, requiring equal employment opportunities for individuals with disabilities, disabled veterans, or veterans of the Vietnam Era; or exercising any rights under VEVRAA or the Rehabilitation Act.

When you actually apply to participate in the Federal Work Study Program you need to commit to understanding our Equal Employment Opportunity/Affirmative Action Policy Statement. If circumstances prevent you from adhering to this policy, it is your responsibility to contact the Federal Work Study Coordinator to inform us of your situation. Please call 802-656-5700 or e-mail Thank you for your consideration.

I have read and understand UVM's EEO/AA Policy Statement policy.


Last modified July 24 2013 02:04 PM