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Non-Degree Students - Index of

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					VERMONT TECHNICAL COLLEGE REGISTRATION FORM
Name (last, first, middle initial)

Return to Registrar PO Box 500 Randolph Center, VT 05061-0500 Term: _________________
student ID or SSN

________________________________________________________________________________________________________________ Mailing address number and street town, state, ZIP code check if changed ________________________________________________________________________________________________________________ Phone (day and evening number, if different) e-mail address ________________________________________________________________________________________________________________ Are you currently enrolled at another VSC school?  yes  no Where?  CCV  CSC  JSC  LSC Are you planning to enroll at another VSC school this term?  yes  no Where?  CCV  CSC  JSC  LSC

DEMOGRAPHIC INFORMATION Complete this section, only if new to the VSC or if there are changes
Social security number : __ __ __ - __ __ - __ __ __ __ Student status:  FRE First-time freshman  TRA Transfer student  REA Readmit  HSS High school  Other ____________ Citizenship: Residency:  US  Vermont R  Non-resident alien  Non-resident: ____________ N Date of Birth: _________________  Resident alien (state) High school graduate: Y N  GED _________________ Student Type: Year: __________ (country)  NEBE/RSP High school: ________________________________________________  OTHER:________________ (name) (state) Educational goals: Do either of your parents have a  Personal Enrichment PE  Improve skills bachelor’s degree: Y N  Unknown  Certificate CT  a better job Get  AD Assoc degree  out college course(s) Try   Bachelor’s degree BS  Take course & transfer Are you a veteran: Y N  Masters degree MA  Other  am applying for VA benefits I  am applying for VOCREHAB benefits I Gender:  Male  Female Marital status:   M Single

Ethnicity:  Asian or Pacific Islander A  Black B  Hispanic H I Native American  Non-Resident alien N  Unknown U  White, Non-Hispanic W   Do you have physical, psychological, or learning disabilities that may require special services or access that you would like to disclose at this time: Y N Explain: ___________________________________________________________________________________________________________________ If you will require special services and would rather contact a learning specialist directly, call (802) 728-1278.

COURSE REGISTRATION
Number & Section Title Location or VIT Site Credits $365/ $696 Tuition Cost Adjustments Subtotal

Degree students may register using this form.
High school students must have an approval letter from their school or take placement exams.

Registration fee ($50) non-degree Activity fee – full-time ($94) or ($8/cr) Campus Center fee for Main campus and Williston - full-time ($125) or ($10/cr) TOTAL

I certify that I have read the statements regarding FERPA & transfer credits and that all information provided by me is correct. Student signature:___________________________________________________ date: ________________
Revised: 11/15/2009

SEE REVERSE SIDE FOR IMPORTANT INFORMATION REGARDING FERPA & TRANSFER CREDIT.

VERMONT TECHNICAL COLLEGE
OFFICE OF THE REGISTRAR PO Box 500 Randolph Center, Vermont 05061-0500

Family Educational Rights and Privacy Act
The Family Educational and Privacy Act (FERPA) is a federal law designed to protect the privacy of student education records. The law gives eligible students, those who have reached the age of 18, or the parents of students under the age of 18, certain rights with respect to their education records. Students have the right to inspect and review all of their education records maintained by the college and to have those records corrected that they believe are inaccurate, misleading or in violation of their privacy rights. Generally, the College must have written permission prior to releasing any academic information from a student’s education record. However, the law allows the college to disclose records without consent to certain officials with a legitimate need or interest in the information. If parents/guardians claim a student as a dependent, they may have access to the student’s educational records without prior written consent. See the Vermont Tech student hand book for more information. For additional information, technical assistance or to file a complaint, you may contact the Family Policy Compliance Office. (202) 260-3887 or om@ed.gov
U.S. Department of Education 400 Maryland Avenue, SW Washington, DC 20202-4605

DIRECTORY INFORMATION The college may also disclose, without consent, “directory type information” that is considered not to be harmful to student, if released. The information considered to be directory information is: name, home and college address, telephone listing and e-mail, date of birth, major, enrollment status, dates of attendance, degree(s) and awards received, weight and height of athletic team members, photographs, most recent educational institution attended, and participation in officially recognized activities and sports. Students may opt out of the release of directory information by submitting a written request to the Office of the Registrar. If directory information is to be withheld, it will be withheld from all parties without authorization or prior student consent. Withholding of directory information will remain in effect until revoked by written request. SPECIFIC STANDING RELEASE OF EDUCATIONAL INFORMATION TO THIRD PARTY Information from my educational records may be released to:

_____________________________________ _____________________________________
(Print full name) (Print full name) (Relationship/Organization) (Relationship/Organization)

_____________________________________ _____________________________________

(Comments/Restrictions)

****** Vermont Statutes Annotated, Title 16, Statute 176, Section 1 (c)
Vermont State law requires that we inform you that credits earned at Vermont Technical College are transferable to other institutions only at the discretion of the receiving institution.


				
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