Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Summer Academy Application Pre-College Course Application Add A Course Before you begin.. Vermont Dual Enrollment students: you will need a voucher number to complete registration. Obtain a dual enrollment voucher. You will need your social security number to complete the application.You can save this form and return later at any time. ERRORThere has been an error with this form-- please begin again. Student Info When do you plan to take this course? Please select... Fall 2023 Student's Name and Email address Full First Name your full and legal first name MIddlePlease select... A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Full Last Name your full and legal last name Student's Email address Use the same email address on all forms for faster service. Confirm student's email address Match? Student email address: I verify that this email account is not shared with another personFor example, if you and a sibling use the same email address, your accounts may become combined and cause registration delays Student Date of Birth MM/DD/YYYY Other Info Highest Level of Education CompletedPlease select... High School Diploma Some High School How did you hear about this program?Please select... Referral from a friend/family member Google/Search Engine Email Newspaper Web Article UVM Website UVM Alumni UVM Current Student Social Media Other Please tell us the "Other" way you heard about this program. Page 2 Student Contact Information Do you have a preferred first name other than the name entered above?YesNo Preferred Name Preferred First Name CountryPlease select... United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Permanent Street Address City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Zip Code ADMIN - Hidden Phone Number Permanent Phone Number Mobile Number Local Phone Number Phone Number Permanent Phone Number Mobile Number Local Phone Number Phone Number Permanent Phone Number Mobile Number Local Phone Number Page 3 Hidden ceeb code interest SUMA Term This is for the opportunity name field. It concatenates with the contact name and interest application name program codePlease select... GLOBAL HSFL SUMA ENGI HSGE ERROR summer program codePlease select... SUMB SUMD SUMH SUMN SUMT SUME SUMG SUMR SUMV SUWR SUAG Course of study High School Course Selection Identify the existing course that you want to replace Course Registration Number (CRN) This is a five (5) digit number. Look up the course number Course Title Cut and paste the exact title Course Selection Method How do you want to select your course?Display a list of entry-level courses (recommended)Allow me to hand-enter any course that UVM offers Select a first and second choice from the list belowThe first column of buttons is for your first choice of course. In case your first choice is not available, the second row of buttons is for your second choice of course. Show me how to select courses Instructions for hand-entering course informationVisit the webpage of the UVM Registrar.Sroll down and click on the correct term under "Schedule Of Courses By Term"Click on "Schedule of Courses" button on the landing page.Select the College/School or SubjectSelect a course. View pre-requisites/notes before selecting this course - you may require permission.Enter the course information below Course Table (make sure you've selected a term above) Loading... Course choice SubjectPlease select... ALAN ANAT ANES ANFS ANNB ANPS ANTH ARBC ARTH ARTS AS ASCI ASL ASTR AT BCOR BIOC BIOE BIOL BIOS BSAD BSCI BUCK CALS CDAE CE CEMS CHEM CHIN CLAS CLBI COMU CRES CS CSD CSYS CTS DNCE EC ECSP EDAR EDCI EDCO EDEC EDEL EDFC EDFS EDHE EDHI EDLI EDLP EDLT EDML EDMU EDPE EDSC EDSP EDSS EDTE EE EMED EMGT ENGR ENGS ENSC ENVS ESOL EXMS FM FOR FP FREN FS FTS GEOG GEOL GERM GKLT GRAD GRK GRMD GRNS GRNU GRS GSWS HCOL HDFS HEBR HLTH HON HP HS HSCI HST HUMN IDM ITAL JAPN LANG LAT LING MAED MATH MATS MBA MD MDPS ME MED MLRS MLS MMG MPBP MS MU NEUR NFS NH NMT NR NSCI NURS OBGY ORTH OSSP PA PATH PBIO PEAC PED PH PHIL PHRM PHYS POLS PORT PRNU PRT PSS PSTG PSYS PT RAD RADT REL RMS RUSS SOC SPAN SPCH STAT SURG SWSS THE TRC VS WFB WGST WLIT WR Course Number Example: 012 Section Example: "OL3" (No spaces) Course Title CRN The Course Registration Number (CRN) is a five-digit identifcation number Course Details Credits Start Date End Date Science Labs Have you selected a laboratory science course? YesNoExamples: Biology (BIOL BCOR) College of Agriculture and Life Sciences (CALS) Engineering (CE, ME, ENGR) Chemistry (CHEM) Geography (GEOG) Physics (PHYS) Geology (GEOL) Lab courses usually are in the following subject areas: BIOL (Biology) BCOR (Biology/BioCore) CALS (College of Agriculture and Life Sciences) CE, ME, ENGR: Engineering CHEM: Chemistry GEOG: Geography GEOL: Geology PHYS: Physics How to register for a lab (for courses selected from the menu above) Check the course list to see if the course requires a choice of labFind a lab that works with your scheduleEnter the lab information below How to register for a lab (for courses entered by hand above) Check the course notes to see if the course requires a lab Find a lab that works with your scheduleEnter the lab information below Lab Details Subject (Lab)Please select... ALAN ANAT ANES ANFS ANNB ANPS ANTH ARBC ARTH ARTS AS ASCI ASL ASTR AT BCOR BIOC BIOE BIOL BIOS BSAD BSCI BUCK CALS CDAE CE CEMS CHEM CHIN CLAS CLBI COMU CRES CS CSD CSYS CTS DNCE EC ECSP EDAR EDCI EDCO EDEC EDEL EDFC EDFS EDHE EDHI EDLI EDLP EDLT EDML EDMU EDPE EDSC EDSP EDSS EDTE EE EMED EMGT ENGR ENGS ENSC ENVS ESOL EXMS FM FOR FP FREN FS FTS GEOG GEOL GERM GKLT GRAD GRK GRMD GRNS GRNU GRS GSWS HCOL HDFS HEBR HLTH HON HP HS HSCI HST HUMN IDM ITAL JAPN LANG LAT LING MAED MATH MATS MBA MD MDPS ME MED MLRS MLS MMG MPBP MS MU NEUR NFS NH NMT NR NSCI NURS OBGY ORTH OSSP PA PATH PBIO PEAC PED PH PHIL PHRM PHYS POLS PORT PRNU PRT PSS PSTG PSYS PT RAD RADT REL RMS RUSS SOC SPAN SPCH STAT SURG SWSS THE TRC VS WFB WGST WLIT WR Course Number (Lab) Example: 012 Section (Lab) Example: "OL3" (No spaces) Course Title (Lab) CRN (Lab) The Course Registration Number (CRN) is a five-digit identifcation number Lab Details Credits (Lab) Start Date (Lab) End Date (Lab) Lab may be required Did you sign up for a lab? Yes!No, my course did not require registering for a separate lab sectionYou will be registered for both the lecture and the lab. How to tell if your course requires a lab section Show me how to find and enter a lab section. Math Course Placement Test Self-selection/Pre-Requisite Check All first-time math students are required to take an online math placement test before the course begins. We will contact you with details. Have you selected a math course above?YesNo Will this be the first math course that you have taken at UVM? YesNoA placement exam is required of first-time math students. Have you met all of the pre-requisites for this course? YesNoPre-requisites must have been taken at UVM. Look up your course to check the pre-requisites. Foreign Language Placement Test Self-selection/Pre-Requisite Check All first-time foreign language students are required to take an online foreign language placement test before the course begins. We will contact you with details. Have you selected a foreign language course above?YesNo Will this be the first foreign language course that you have taken at UVM? YesNoA placement test exam is required of all students taking a foreign langue course at UVM for the first time. Have you met all of the pre-requisites for this course? YesNoPre-requisites must have been taken at UVM. Look up your course to check the pre-requisites. Summer Academy Residential/Commuter Summer Academy offers a residential and commuter option. Which do you prefer? ResidentialCommuterSee the details about the summer academy residential and commuter options Online onlyAdventures in Neurscience is offered online and does not have a residential/commuter option Page 4 Demographic information Student Citizenship Are you a US Citizen or US permanent resident?YesNo Social Security Number Student Social Security Number (Encrypted for Privacy) Enter with no dashes or hyphens (ex: 000000000) Re-enter Social Security Number Match? Non Citizen/Non Permanent Resident Visa StatusI currently hold a non-immigrant visa.I have been granted permanent U.S. residency.I hold refugee or asylee statusNot applicable - I will not be entering the United States Visa Type ex. F-1; J-1; L-2; H-4 Alien Registration Number Student Information Student's Legal GenderFemaleMale Military StatusPlease select... Active Inactive Dependent Veteran None Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Please select... Yes NoNote that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential. Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? Please select... Yes NoThese actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. Please describe the details misdemeanor/felony/disciplinary action Race/Ethnicity The section below is optional Hispanic or LatinoPlease select... Yes No Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: Asian American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander White Page 5 High School Information Please choose the state where you attend High SchoolPlease select... I do not attend High School in the United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Current High School Expected High School Graduation YearPlease select... 2023 2024 2025 2026 Please select the Vermont high school that you attend Please select... Not Listed Below Home School Acad.for Global Exploration - Killington Arlington Memorial High School - Arlington Austine School for the Deaf - Brattleboro Avalon Triumvirate Academy - Fairfax Bellcate School - Winooski Bellows Falls UHS - Bellows Falls Bellows Free Academy - Fairfax Bellows Free Academy - St. Albans Black River High School - Ludlow Blue Mountain Union School - Wells River Brattleboro Union High School - Brattleboro Bromley Brook School - Manchester Center Burke Mountain Academy - East Burke Burlington High School - Burlington Burlington Technical Center - Burlington Burr and Burton Academy - Manchester Cabot High School - Cabot Caledonia School Canaan Memorial High School - Canaan Center for Technology Essex - Essex Junction Central Vermont Academy - Barre Champlain Valley Christian Sch - Vergennes Champlain Valley UHS - Hinesburg Chelsea High School - Chelsea Christ Covenant School - Marshfield Christian Heritage School - Brattleboro Colchester High School - Colchester Community HS of Vermont - Waterbury Concord High School - Concord Cornerstone Christian School - Lyndonville Cornerstone School - Saint Johnsbury Craftsbury Academy - Craftsbury Common Danville High School - Danville East Burke School - East Burke Eckerd Wilderness School - Benson Enosburg Falls High School - Enosburg Falls Essex High School - Essex Junction Fair Haven Union High School - Fair Haven Faith Bible Academy - West Rutland Gailer School - Middlebury Grace Christian School - Bennington Green Mountain UHS - Chester Green Mountain Valley School - Waitsfield Hartford High School - White River Junction Harwood Union High School - So. Duxbury Hazen Union High School - Hardwick Killington Mountain School - Killington King George School - Sutton Lake Champlain Waldorf School - Charlotte Lake Region Union High School - Orleans Lamoille Union High School - Hyde Park Leland And Gray UHS - Townshend Liberty High School - Brattleboro Lyndon Institute - Lyndon Center Mid Vermont Christian School - White River Junction Middlebury Union High School - Middlebury Mill River Union High School - North Clarendon Milton High School - Milton Missisquoi Valley UHS - Swanton Montpelier High School - Montpelier Mount Abraham UHS - Bristol Mount Anthony UHS - Bennington Mount Mansfield UHS - Jericho Center Mount Snow Academy - Mount Snow Mount St. Joseph Academy - Rutland Mountain Sch Of Milton Academy - Vershire Newbury Christian School - Newbury North American Hockey Academy - Stowe North Country UHS - Newport Northfield Middle High School - Northfield Northlands Job Corps Academy - Vergennes Oak Meadow School - Brattleboro Okemo Mountain School - Ludlow Otter Valley Union High School - Brandon Oxbow High School - Bradford Peoples Academy - Morrisville Pine Ridge School - Williston Potter's House School - Hartford Poultney High School - Poultney Proctor High School - Proctor Putney School - Putney Randolph Union High School - Randolph Red Cedar School - Bristol Rice Memorial High School - South Burlington Richford High School - Richford Rochester High School - Rochester Rock Point School - Burlington Rutland Academy - Rutland Rutland Area Christian School - Rutland Rutland High School - Rutland Sharon Academy - Sharon South Burlington High School - South Burlington South Royalton High School - South Royalton Spaulding High School - Barre Springfield High School - Springfield St. Johnsbury Academy - St. Johnsbury Stowe High School - Stowe Strafford Technical Center - Rutland Stratton Mountain School - Stratton Mtn The Compass School - Westminster Station The Long Trail School - Dorset The Maplehill School - Plainfield Thetford Academy - Thetford Trinity Baptist High School - Williston Troy Academy of Green Mt Coll - Poultney Twin Valley HS (Wilmington HS) - Wilmington Twinfield High School - Plainfield Union 32 High School - Montpelier Union Baptist Christian School - St. Johnsbury United Christian Academy - Newport Vergennes Union High School - Vergennes Vermont Acad of Sci. & Tech. - Randolph Center Vermont Academy - Saxtons River Vermont Commons School - South Burlington Websterville Baptist Christian - Websterville Wellspring Life Christian Acad - Rutland West Rutland High School - West Rutland Whitcomb High School - Bethel Whitingham School - Jacksonville Wildridge Academy - West Burke Williamstown High School - Williamstown Windsor High School - Windsor Winooski High School - Winooski Woodstock Union High School - WoodstockIf the school you attend is not listed, please select "Not Listed Below" from the top of the list Please enter the name of your high school Would you like to be considered a Vermont resident for tuition purposes? YesNoEven if you live in Vermont, you must complete this section in order to be considered for in-state residency status. In-state residency is based on UVM Residency Policy Vermont Residency Vermont Residency QuestionnaireIn 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.Learn more about UVM residency criteria Have you been employed at any point during the last 2 years? YesNonot needed for pre-coll per residency officer April 2016 Employers Please list employers for the last two years below Employer Employer Name City State/ProvincePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Yukon Territory Are you currently employed by this employer?YesNo Start Date MM/DD/YYYY End Date MM/DD/YYYY (list today's date if currently employed) List all states in which your parents have filed resident income tax the last 3 years (see example below) When was the last year you were claimed as a dependent by your parents for tax purposes?Please select... 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2009 2007 2006 2005 2004 2003 2002 2001 2000 or earlier In what state will you graduate from high school?Please select... have not graduated graduated outside of U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau When did you begin living in Vermont? MM/DD/YYYY Parent/Guardian's Permanent Address Street Address City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Zip Code CountryPlease select... United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Which address do you reside at currently?The Parent'/Guardian's address, listed above.The Permanent address entered on the first page of this formOther (please enter below) How long have you resided at your current address? Enter years and months (i.e. 10 years, 2 months) Other address Other Street Other City Other State/ProvincePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Other Zip/Postal Code Other CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe 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. Page 6 Reduced-Tuition Program Eligibility Do you expect to be considered a Vermont resident for tuition purposes? YesNoMore information about Vermont residency What year will you be in school at the time you begin your course?Junior (completed Sophomore year but not Junior year) Senior (completed Junior year but have not yet graduated)Neither Will you be using a Dual Enrollment voucher for this course? YesNo Dual Enrollment Based on your answers above, you may qualify for a Dual Enrollment Voucher. Dual Enrollment vouchers allow Vermont high school students to take up to two college courses total during their Junior and Senior years at a reduced price. Learn more about Dual Enrollment and Watch How To Videos. Vouchers Are you planning to use a Dual-Enrollment Voucher to pay the tuition for this course? YesWe will notify you when the State of Vermont has made dual enrollment vouchers available. I understand that applications will be considered in the order received. Course registration will not be complete until students have submitted a voucher to UVM. Acknowledgement of financial responsibility I understand that Dual Enrollment students are responsible for the comprehensive fee and any other fees See fee details Dual Enrollment Voucher Entry Please enter the voucher number that you intend to use for this course. Apply for a voucher (you can save this form and resume later if you like -- see top of page). Please verify the voucher number by entering it again Match? Approvals Guidance Counselor Communication Enrolling in a course at UVM while in high school may have implications for your high school education. Please acknowledge below that you will be in communication with your guidance counselor about your educational plans at UVM. Guidance Counselor AcknowledgementI will contact my guidance counselor to confirm that my upcoming course at UVM is part of my personalized learning plan. Guidance Counselor first name Guidance counselor last name Guidance Counselor phone number International Guidance Counselor Phone # Guidance counselor email address Parent/Guardian Contact Information Parent/Guardian First Name Parent's Last Name Parent/Guardian Phone International Parent/Guardian Phone Parent/Guardian email address We will contact this address to approve course selection and for payment of the deposit. Confirm parent's email address Match? Student and parent must use different email addresses. ADMIN Phone Numbers Guidance Counselor phone number Parent/Guardian home phone number FERPA Acknowledgement I understand that by taking this course (or program if participating in a precollege program) at the University of Vermont, any information related to my current enrollment, attendance and performance in this course (or program) can be shared with the principal or designee at my high school. FERPA Part 2I also give permission for any information related to my current enrollment, attendance and performance in this course (or program if participating in a precollege program) to be released to my parents/guardians including consent to release grades and any information in my Continuing and Distance Education record. Page 7 Terms and Conditions Agreement to General Terms and ConditionsI have read and agree to the terms and conditions linked to below.Yes PLEASE READ - SCROLL TO THE BOTTOMResponsible for all charges billedI understand that by submitting this course registration I am entering into a financial arrangement with UVM and I accept responsibility for all charges billed to the student’s UVM account.Billing noticesI understand that UVM student bills will be posted online in the UVM Student Information System (MyUVM) and that all billing notices will be sent to the student’s UVM assigned e-mail address and that it is my responsibility to review and pay the bill before the due date on the bill.Email communication regarding billingI understand that I may also receive direct e-mail communication from UVM Student Financial Services, including billing notifications and reminders.DisputesI understand that all disputes about registration or payment will be governed by Vermont law and subject to the jurisdiction of the courts in Vermont.False informationI understand that false information on the Dual Enrollment application may result in the student being held responsible for tuition.Contact by telephoneI authorize the University and its agents and contractors to contact me regarding my account at any telephone number I provide.For more information about tuition, fees, and UVM billing procedures, visit UVM Student Financial Services.Program cancellation acknowledgementI understand that UVM reserves the right to cancel this program due to insufficient enrollment or any other reason which would impact the quality or viability of the program. Page 8 Terms and Conditions (cont.) Acknowledgement of Financial ResponsibilityI have read and agree to the terms and conditions linked to below.Yes PLEASE READ - SCROLL TO THE BOTTOMReview policies and proceduresI understand that I am responsible for reviewing UVM’s tuition refund policy and other required add/drop and withdrawal procedures of the University, and that the student’s non-attendance of courses does not relieve me of any tuition or course charges. Please review policies and important dates at the links below:Tuition refund policyImportant datesLate feesI understand that accounts not paid when due are subject to a late fee and a hold preventing registration and access to grades and transcripts.Delinquent accountsI understand that seriously delinquent accounts may be placed with an outside collection agency or reported to the national credit bureau system. I agree to reimburse the University all collection agency fees, up to a maximum of 40% of the debt (or the highest amount allowed by law), together with attorney’s fees and all other costs and charges necessary for the collection of any amount not paid when due.Responsibility for Student FeesI understand that, in addition to any tuition charges, I am responsible for paying the comprehensive fees, and all course fees, lab fees, and/or program fees that may apply based on the course at the full rate regardless of any tuition discount. Please note, the Dual Enrollment voucher applies to tuition only. All other fees are the responsibility of the student. Please note: comprehensive fees may be $400 or more if you take more than one class per semester I have reviewed the schedule of rates below and understand what I will be charged for comprehensive fees. Schedule of Rates Academic year rates (spring and fall) Summer rates Summer Academy Tuition and Fees *The comprehensive fee is mandatory and covers the use of facilities such as the Davis Center, shuttle bus services, library services, etc. These fees are payable online via electronic check or credit card. See the 'Direct Payment Options' section. Save my progress and resume later | Resume a previously saved form Contact InformationYour Rights Under GDPR