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LLC Application Form
Lyndon Learning Collaborative (LLC) Application
What We Look For In an Applicant
A Challenging High School Program
Advanced Placement (AP), college prep, and honors courses are recommended but not required. A score of 3 or higher on an Advanced Placement examination will be accepted for college credit.
Evidence of Leadership
Participation in extracurricular activities such as community service, athletics (captain or co-captain), clubs, organizations, church groups, civic groups, etc., can strengthen your application.
You Are Unique
Each student is unique; therefore we look carefully at all the information provided to us. There are many circumstances that can affect academic performance. If you have extra-ordinary circumstances, please let us know and we will take this information into consideration when we decide on your admissibility.
Timelines
Application Deadline: April 26, 2019 for the 2019/2020 Academic Year
Application Requirements
All prospective LLC students must submit the following:
Completed LLC application
Letter of recommendation
Official High School transcripts (A minimum 3.0 GPA is required, based on a recalculated GPA, utilizing only academic courses)
Personal Essay
Send all materials to and direct your questions to:
Kasey Potter, M.Ed.
Director of Guidance
Student Services, Lyndon Institute
168 Institute Drive
Lyndon Center, VT 05850
Kasey.Potter@LyndonInstitute.org
Desk: 802.535.3671
Fax: 802.535.3632
For NVU-Lyndon specific questions:
Lexi Damato
Assistant Director of Admissions
Early College and Dual Enrollment Coordinator
Lexi.Damato@NorthernVermont.edu
Desk: 802.626.6499
Fax: 802.626.6335
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Biographical Information
First Name
Middle Name
Last Name
Preferred First Name
Do you have any former legal names?
Yes
No
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
District of Columbia (D.C.)
Have you maintained legal residence for the last 12 months?
Yes
No
Country of Citizenship
Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas Da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius, and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos Islands (Keeling Islands)
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Coral Sea Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Federated States of Micronesia
Fiji
Finland
Foreign/Unknown
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau, the Pacific Islands of
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Are you a permanent resident of the U.S.?
Yes
No
Country of Birth
Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas Da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius, and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos Islands (Keeling Islands)
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Coral Sea Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Federated States of Micronesia
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R.
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jersey
Jordan
Juan De Nova Island
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau S.A.R.
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau, the Pacific Islands of
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Are you currently living in the US?
Yes
No
Alien Registration Number
What is your current status? (example: F-1)
Social Security Number (optional)
Date of Birth
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
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13
14
15
16
17
18
19
20
21
22
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28
29
30
31
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
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2003
2002
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1998
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1991
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1989
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1986
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1982
1981
1980
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1977
1976
1975
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1972
1971
1970
1969
1968
1967
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1965
1964
1963
1962
1961
1960
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1958
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1950
1949
1948
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1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
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1926
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1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Sex assigned at birth
Female
Male
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?
Yes
No
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)?
Yes
No
*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
Academic
Disciplinary
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
Father
Legal Guardian
Mother
Step-Father
Step-Mother
First Name
Last Name
Mailing Address (If different)
Country
Street
City
Region
Postal Code
Phone Number
Email Address
Employer
Highest Level of Education
Did not complete high school
High school diploma or GED
Some college
Associate's degree
Bachelor's degree
Graduate degree
Other/don't know
Name of college attended
Parent/Legal Guardian #2
Relationship
Father
Legal Guardian
Mother
Step-Father
Step-Mother
First Name
Last Name
Mailing Address (If different)
Country
Street
City
Region
Postal Code
Phone Number
Email Address
Employer
Highest Level of Education
Did not complete high school
High school diploma or GED
Some college
Associate's degree
Bachelor's degree
Graduate degree
Other/don't know
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
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
End Date (if present, put current date)
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Job #2
Employer
Position
Country
City
Region
Postal Code
Start Date
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
End Date
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Job #3
Employer
Position
Country
City
Region
Postal Code
Start Date
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
End Date
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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
No
How many family members have attended?
1
2
3
4
More than 4
Relative #1
First Name
Last Name
Relationship
Brother
Father
Legal Guardian
Mother
Sister
Relative #2
First Name
Last Name
Relationship
Brother
Father
Legal Guardian
Mother
Sister
Relative #3
First Name
Last Name
Relationship
Brother
Father
Legal Guardian
Mother
Sister
Relative #4
First Name
Last Name
Relationship
Brother
Father
Legal Guardian
Mother
Sister
*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?
Yes
No
*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.*
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?
Attachment
Text-box
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
First-Year Applicant
International Applicant
Readmission Applicant
Early College Applicant
Dual-Enrollment Applicant
NVU Online Applicant
Graduate Applicant
Transfer Applicant
Online Early Childhood Education (ECE) Applicant
LLC Applicant
NVU Application 20-21
2018 ED
2018 RD
NVU Application 19-20
Early College Application
Graduate Application
NVU Online Application
Undergraduate Application
Yes
No
Yes
No
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.
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