Pre-college Registration

Web

PERSONAL INFORMATION

First Name*

Middle Initial

Last Name*

Is there a prior name under which application materials may have been previously received?*

Former Name

First Name

Middle Name

Last Name

Country

Gender

Male Female

Social security number - will be encrypted for privacy *

enter with no dashes or hyphens (ex: 000000000)

Date of birth*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Email*

xxHave you ever been convicted of a crime OR been the recipient of any disciplinary action by an institution of higher education? (Mark yes if any criminal or disciplinary actions are pending as well).

Yes No

replaced by the 2 questions below in Feb 2013 to separate out the crime and disciplinary actions

Have you ever been convicted of a crime? Mark "yes" if any criminal actions are pending as well.*

Yes No

Have you been the recipient of any disciplinary action by an institution of higher learning? Mark “yes” if any disciplinary actions are pending as well.*

Yes No

Permanent Address

Address 1*

Address 2

City*

State*

Zip Code/Postal Code

Do you have a local (Vermont) address that is different than the address above?

Local Address

(if different from above)

Address 1

Address 2

City

State

Zip Code/Postal Code

Country_local_address

hidden 1/10/12 since it's not relevant to local addresses

Phone Numbers

Permanent Area Code*

enter 3 digits only, without parentheses

Permanent Exchange and number*

no spaces or hyphens, i.e.: XXXXXXX

Local Area Code

enter 3 digits only, without parentheses

Local Exchange and number

no spaces or hyphens, i.e.: XXXXXXX

Mobile Area Code

enter 3 digits only, without parentheses

Mobile Exchange and number

no spaces or hyphens, i.e.: XXXXXXX

Race and Ethnicity

Are you Hispanic or Latino?

Yes No

American Indian or Alaska Native

Yes No

Asian

Yes No

Black or African American

Yes No

Native Hawaiian or Other Pacific Islander

Yes No

White

Yes No

Citizenship

Are you a US Citizen?*

Yes No

For Non-US citizens

Visa Status

I currently hold a non-immigrant visa. I will be applying for a student F-1 or J-1 visa. I have been granted permanent U.S. residency.

Please state Visa Type:

ex. F-1; J-1; L-2; H-4; other

Alien registration number

Vermont Residency

Do you intend to register as a Vermont resident for tuition purposes?*

Yes No

Learn more about UVM residency criteria

Vermont Residency Questionnaire

In order to be considered for in-state tuition, you must complete this section. The final decision on residency is made by the residency office. Regardless of your responses below, it is the student's responsibility to understand their final residency determination before they register. The residency office may request additional information before determining residency status. All Applications for In-State Status should be received no later than the last day of the Add/Drop period for the semester for which in-state status is sought. All applications received after the Add/Drop period will be considered for the following semester for which the student is enrolled.

Were you born in Vermont?

Yes No

When did you first begin living in Vermont?*

Where is Your True, Fixed and Permanent Address

City

State

Zip Code

How long have you resided at the address above?*

enter years and months (i.e. 10 years, 2 months)

Where is Your Parent/Guardian's True, Fixed and Permanent Address*

City

State

Zip Code

Country

For Vermont Residents Only: The information above does not change the residency status established at your last enrollment. For information on filing for in-state status, contact the Residency Office, Registrar's Office, 85 South Prospect St., (802) 656-8515.

Information is also available online under Policies & Procedures on the Registar's webpage.

Please indicate the term you intend to enroll:*

PROFESSIONAL CHOICE

Please check the profession(s) you are interested in pursuing.

Medicine

Yes No

Dentistry

Yes No

Veterinary Medicine

Yes No

Physician Assistant

Yes No

Nurse Practitioner

Yes No

Physical Therapy

Yes No

SLPA Professional Growth

Do you have access to a school-based Speech-Language Pathologist who is certified by ASHA for supervision during this SLP-Assistant Program?*

Yes No Not Sure

Are you intending to use these courses as preparation for a UVM MS in Communication Sciences? *

Yes No Not Sure

Are you committed to service as a Speech-Language Pathology Assistant in the schools?*

Yes No Not Sure

Brain Research and Learning: Reasons for Applying

Please describe briefly your reasons for applying to this program*

Licensure Endorsement Using as part of a Master's Degree Professional Development

Other:

Check all that apply

Pre-college Course Selection

Enter the courses that you would like to take below. You can look up the course information if needed.

First Choice

First choice: Course Registration Number and Title*

EG: 90130 General Psychology

Subject, Course Number, and Section Code (first choice)*

i.e. PSYC 001 B

Days/hrs offered (first choice)*

i.e. MWF 10-11am

Second Choice

Second Choice: Course Registration Number and Course Title

EG: 90130 General Psychology

Subject, Course Number, and Section Code (second choice)

i.e. PSYC 001 B

Days/hrs offered (second choice)

i.e. MWF 10-11am

Math Placement

Have you selected one or more math courses above?*

Have you taken a math course at UVM before?*

Yes No

Math Readiness acknowledgement*

I understand that if this is my first time taking a University level Math course I must complete the Math Placement Test and call 656-2085 to discuss the results and be placed accordingly into the appropriate section for my level.

You will be sent a link to the test

Parent and/or Guidance Counselor Contact Information

We will be contacting your parents and/or guidance counselor regarding the course(s) that you select.

Email Address of your High School Guidance Counselor*

We will contact this address requesting that he/she approve your course selection.

Parent's Email Address*

We will contact this address to approve the terms and conditions and course selection

How will this experience fit with your personal and academic goals?*

1 paragraph

HS Course 1

hidden to users, revealed for testing

HS Course 2

hidden to users, revealed for testing

Dublin Course title

populated into the main course title field (input#field17618848) via jquery in populate.js

Letter of reference

File uploads may not work on some mobile devices.

Please include a letter of reference from an adult who can speak your appropriateness for this program.

High School Summer Academy

Summer Academy Course: First Choice*

UVM Jump Start Courses

You will be registered for:

Natural Resources: Sustainable Landscape Ecology
ENVS 095 – Climate Change and the Environment

After clicking 'Submit Form' below, you will be directed to the payment form.

UVM JumpStart Course Title 1

hidden-- used to populate HS course title 1 field only

UVM JumpStart Course Title 2

hidden-- used to populate HS course title 2 field only

ETEC: Teaching Experience

Please list current and past teaching experience*

Include dates, duration, grade level, subject(s), school, town and state

Guaranteed Admission Program (GAP)

Have you applied for admission to UVM in the past?*

Yes No

Have you applied for admission to the GAP program in the past?*

Yes No

What do you consider to be your academic strengths?

2-3 sentences

Which academic areas do you consider your passion-- which do you gravitate toward?

2-3 sentences

Where do you see yourself professionally in 5-10 years?*

2-3 sentences

Please review the possible GAP Curriculum Choices. Select the college or school below that best matches your interests*

College of Agriculture and Life Sciences College of Arts & Science College of Education and Social Services College of Engineering and Mathematical Sciences College of Nursing and Health Sciences Rubenstein School of Environment and Natural Resources School of Business Administration Unsure

Financing plan*

I have not yet developed a plan for financing my studies. I have developed a plan for financing my studies.

For information about financial aid and paying for your education, UVM's Student Financial Services Office can be reached at 802-656-5700 or via uvm.edu/sfs

Are you planning to initiate financial aid?

Yes No

FAFSA*

I have completed a FAFSA

A FAFSA can be downloaded at fafsa.gov. UVM's school code is 003696

Housing*

UVM Housing Live at home I plan to participate in GAP Online Other

Add/Drop/Withrawal*

I understand the add/drop/withdrawal policies as indicated in the link below

Review add/drop/withdrawal policies

Do you qualify for UVM tuition remission?*

Yes No

You or one of your parents must be a current UVM employee to qualify.

Military Status

Active Inactive Dependent Veteran none

Are you an ROTC student planning on enrolling in Military Studies courses?

Yes No

Have you ever taken a course at UVM before?

Yes No

High School

Grade

High School Graduation Year

(anticipated or actual). Please enter with no dashes or hyphens (ex: YYYY)

Primary High School (choose state or province)*

Please choose the location of the high school you intend to graduate from

Primary High School (select name)

Please select the high school that you have graduated from or intend to graduate from

Primary High School 1 - hidden to users

Secondary High School

Yes No

Is there another high school that you have attended in addition to the one listed above?

Secondary High School (choose state or province)

Secondary High School (select name)

Please select the high school that you have attended or are attending

Secondary High School 2 hidden to users

Colleges Attended

How many colleges have you attended where you have earned college credit?*

None 1 2 3 4 5 More than 5

transcripts are required for all college credit work

College Attended

Complete for all undergraduate, graduate or professional schools attended. Schools not listed may be added to the "Additional colleges or universities attended" section below

Please submit official transcripts for all schools listed.

College #1

College 1 (choose state or province)*

Select the US State, Province, or Territory in which your college or university is located

College 1 (select name of college or university)

College 1- College Name -- hidden to users

Start date of attendance (College #1)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

End date of attendance (College #1):*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Degree received (College #1)*

College #2

College 2 (choose state or province)*

Select the US State, Provice, or Territory in which your college or university is located

College 2 (select name of college or university)

College 2- College Name -- hidden to users

Start date of attendance (College #2)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

End date of attendance (College #2)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Degree received (College #2)*

College #3

College 3 (choose state or province)*

Select the US State, Provice, or Territory in which your college or university is located

College 3 (select name of college or university)

College 3- College Name -- hidden to users

Start date of attendance (College #3)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

End date of attendance (College #3)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Degree received (College #3)*

College #4

College 4 (choose state or province)*

Select the US State, Provice, or Territory in which your college or university is located

College 4 (select name of college or university)

College 4- College Name -- hidden to users

Start date of attendance (College #4)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

End date of attendance (College #4)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Degree received (College #4)*

College #5

College 5 (choose state or province)*

Select the US State, Provice, or Territory in which your college or university is located

College 5 (select name of college or university)

College 5- College Name -- hidden to users

Start date of attendance (College #5)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

End date of attendance (College #5)*

Please enter with no dashes or hyphens (ex: MMDDYYYY)

Degree received (College #5)*

Additional Colleges

Below, please list any additional undergraduate, graduate or professional schools attended beyond the five listed above

Please send official transcripts for all schools listed.

Additional colleges or universities attended (including institutions not listed above)

Please list any additional colleges or universities attended, one per line

EMPLOYMENT HISTORY/PERSONAL STATEMENT

Upload Resume (include education, employment, and volunteer history with dates)*

File uploads may not work on some mobile devices.

Upload Resume

Personal Statement*

File uploads may not work on some mobile devices.

Please see our admissions requirements page for personal statement guidelines

VOLUNTEER HISTORY

Organization

Position

Hours per week

Dates

(start-end)

Applicant's Signature/Date*

I certify that the above information is true and correct

High School Payment Option

Voucher Number

residency

hidden field

College

program_attribute

add all program to this list

output_file

Degree

Major

ce source

inquiry status

record type

for salesforce

interest

url

timeStamp

:

orderType

for Nelnet integration

amount

(in cents: i.e. 5000 = $50) for Nelnet integration

redirectURL

for Nelnet integration

TransactionID

for Nelnet integration (populated after Nelnet transaction is completed)

TransactionType

(1= credit card) for Nelnet integration (populated after Nelnet transaction is completed)

TransactionStatus

(1= accepted) for Nelnet integration (populated after Nelnet transaction is completed)

TimeFlag

(Y = successful) for Nelnet integration (populated after Nelnet transaction is completed)

HashFlag

(Y = successful) for Nelnet integration (populated after Nelnet transaction is completed)

Continuing Education | your doorway to academic excellence

Pre-College

Submit this form in order to complete your pre-college registration with UVM Continuing Education

PERSONAL INFORMATION

Permanent Address

Local Address

Phone Numbers

Race and Ethnicity

Citizenship

For Non-US citizens

Vermont Residency

Vermont Residency Questionnaire

PROFESSIONAL CHOICE

Please check the profession(s) you are interested in pursuing.

SLPA Professional Growth

Brain Research and Learning: Reasons for Applying

Pre-college Course Selection

First Choice

Second Choice

Math Placement

Parent and/or Guidance Counselor Contact Information

High School Summer Academy

UVM Jump Start Courses

After clicking 'Submit Form' below, you will be directed to the payment form.

ETEC: Teaching Experience

Guaranteed Admission Program (GAP)

High School

Colleges Attended

College Attended

Complete for all undergraduate, graduate or professional schools attended. Schools not listed may be added to the "Additional colleges or universities attended" section below

Please submit official transcripts for all schools listed.

College #1

College #2

College #3

College #4

College #5

Additional Colleges

Below, please list any additional undergraduate, graduate or professional schools attended beyond the five listed above

Please send official transcripts for all schools listed.

EMPLOYMENT HISTORY/PERSONAL STATEMENT

VOLUNTEER HISTORY