LLC Application Form

Biographical Information

First Name

Middle Name

Last Name

Preferred First Name

Do you have any former legal names?

Former Last Name #1

Former Last Name #2

Permanent Address

Country
Street
City
Region
Postal Code

Mailing Address (If Different From Above)

Country
Street
City
Region
Postal Code

State of Legal Residence

Have you maintained legal residence for the last 12 months?

Country of Citizenship

Are you a permanent resident of the U.S.?

Yes

Country of Birth

Are you currently living in the US?

Yes

Alien Registration Number

What is your current status? (example: F-1)

Social Security Number (optional)

Date of Birth

Sex assigned at birth

I identify as...

Personal/Contact Information

Email Address

Phone Number (Home)

Phone Number (Mobile)

The following information is used for statistical reporting to federal agencies to assure equal opportunity for all students. This optional information will not be used by the Admissions Office to make any decisions pertaining to your acceptance.

Are you Hispanic or Latino?

Select one or more of the following to describe your racial background:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

Language spoken at home (If not English)

Educational Information

List all high schools attended with most current institution first.

School #1

Name

CEEB Code

School #2

Name

CEEB Code

School #3

Name

CEEB Code

List any high school academic credentials (honors, dean's list, etc.) and year(s) awarded.

Please select all that apply:

I have taken the SAT

I have taken the ACT

I have taken the TOEFL, ELPT, or APIEL

Have you ever been subject to disciplinary action or do you currently have disciplinary charges pending by any educational institution due to academic (such as, but not limited to, cheating or plagiarism) or behavior misconduct (such as, but not limited to, violence, drug use or sexual harassment/assault)?

*You must notify the Admissions Office promptly if your "no" answer ceases to be accurate after you submit this application. Your failure to do so may be grounds to deny or withdraw your admission, or subject you to disciplinary sanctions after enrollment.*

Reason

Explanation of Disciplinary Violation

Academic Interests

Please tell us what academic areas are of interest to you, or if there is a major you would like to pursue.

Parent/Guardian Information

Parent/Legal Guardian #1

Relationship

First Name

Last Name

Mailing Address (If different)

Country
Street
City
Region
Postal Code

Phone Number

Email Address

Employer

Highest Level of Education

Name of college attended

Parent/Legal Guardian #2

Relationship

First Name

Last Name

Mailing Address (If different)

Country
Street
City
Region
Postal Code

Phone Number

Email Address

Employer

Highest Level of Education

Name of College Attended

Extracurricular and Athletic Activities

List any extracurricular, community service, and/or volunteer activities in which you have been involved.

List any individual athletic honors you have received

Work History

List your three most recent jobs (If you have a substantial work history you would like to share, please send an attached resume to Lexi.Damato@NorthernVermont.edu)

Job #1

Employer

Position

Country
City
Region
Postal Code

Start Date

End Date (if present, put current date)

Job #2

Employer

Position

Country
City
Region
Postal Code

Start Date

End Date

Job #3

Employer

Position

Country
City
Region
Postal Code

Start Date

End Date

Miscellaneous

How did you hear about Lyndon Learning Collaborative (LLC)?

Admissions Representative

Alumnus/Alumna

Coach

College Fair

Employer

Other

Publication

School Counselor

Social Media

Student

Teacher

Website

Do you have immediate relatives who have attended (or are currently attending) Northern Vermont University?

Yes

How many family members have attended?

Relative #1

First Name

Last Name

Relationship

Relative #2

First Name

Last Name

Relationship

Relative #3

First Name

Last Name

Relationship

Relative #4

First Name

Last Name

Relationship

*Note that you are not required to answer "yes" to the following 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 convicted of, or charged with, a criminal offense or are you currently the subject of any criminal proceeding?

Please provide an explanation including the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience. Your application may not move forward without such written explanation. Your "yes" answer will not necessarily preclude you from being admitted, however, your failure to provide complete, accurate and truthful information may be grounds to deny or withdraw your admission, or subject you to disciplinary sanctions after enrollment.

Personal Essay

Please write a statement of 250 words (or more) about the following:
Discuss some issue of personal, local, national, or international concern and its importance to you.

How do you prefer to submit your essay?

Personal Essay

I Hereby Declare

I understand that withholding information requested in this application or giving false information may make me ineligible for admission to or continuation at a Vermont State Colleges System (VSCS) institution. I certify that the above statements are correct and complete. I understand that Northern Vermont University may wish from time to time to provide public notice of certain student accomplishments and/or to use photographs of students for publications in various types of college promotional material. I do hereby give my permission to Northern Vermont University to provide public notice of my accomplishments as it may feel appropriate, and/or use my photograph, without compensation, in published promotional material.

Applicant's Full Name

Date

Parent/Guardian's Full Name (required if applicant is under 18 years of age)

Date

Information: Credits earned within the Vermont State Colleges System (VSCS) are transferable to other colleges or universities only at the discretion of the receiving institution. Information provided on the application form will be released to other Vermont State Colleges for admission purposes. Applicants who have any disability (physical or learning) or who have limited English proficiency are encouraged to contact the Admissions Office or Academic Adviser so that special accommodations can be made to assist students throughout the admissions process and/or in the classroom.
Confidentiality of Admissions Records: The material submitted in support of your application will be kept confidential by the Office of Admissions. It will not be released without the approval of the Admissions Director, and then only when necessary for bona fide educational purposes. Excepting transcript information and this application form, no part of your admissions file will become part of your permanent education record at NVU. The Vermont State Colleges System (VSCS) maintains a single student system. Information and documentation provided by an applicant or a student, including high school and college transcripts, may be shared with any of the Vermont State Colleges to which an applicant or student applies or otherwise directs the information to be sent, or as may otherwise be permitted by law.
Non-Discrimination, Equal Opportunity and Affirmative Action Statement: Qualified students are recruited for, admitted to, and participate in all college programs without discrimination on the basis of race, color, sex, sexual orientation, religion, creed, national origin, age, veteran status, or disability. NVU will provide reasonable accommodations to create to create equal opportunity for students with known disabilities. Please contact the Dean of Enrollment if auxiliary aid or service is needed to apply for admissions.
The U.S. Department of Education requires colleges to make available annual statistics related to any campus crimes and our students' continuation rates. Please contact the Student Administrative Services office for a copy of this information.
Please be advised: The VSCS maintains a single course database, student records system and official transcript for all VSCS colleges (NVU, CCV, CU, VTC). If you are a student at one VSCS college and are applying to another VSCS college, your official transcript will be reviewed electronically by the admissions office at the VSCS college to which you are applying. By signing above, you grant permission for an electronic review of your official VSCS transcript by the admissions office at the VSCS college to which you are applying.