Thank you for your interest in our TRIO Student Support Services program at Johnson.  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (802) 635-1259.
 
Student Information
First Name *
Middle Initial *
Last Name *
Preferred Name *
Date of Birth *
Home Phone *
Cell Phone Number *
May we text you periodically with reminders and timely information to support your success?
College Email Address
University 7 Digit ID *
Johnson's Academic Support is funded in part by a TRIO Student Support Services grant from the U.S. Department of Education.  This grant enables VTSU Johnson to provide additional academic support services to students who ae first generation college students, low-income students, or students with documented disabilities.  Your answers to the questions below will assist us in determining your eligibility.
Family Information
With whom do you live? (or, if independent, whom did you live with at age 18? *
Are you currently in foster care or aging out of the foster care system? *
What is the highest level of education completed by either parent (biological or adoptive)? *
Parent's Email Address (Leave blank if not available)
Have you applied for Financial Aid? *
Did you receive a Pell Grant this year? *
Academic Information
Do you have a documented physical or learning disability? *
Do you have a college degree?
What kind of degree and from what college?
When do you anticipate graduating?
What is your major or career goal?
Please describe at least three areas where you are strong academically.
What specific academic needs do you have that you believe could potentially impact your success at VTSU? Please select from the below drop-down menu options.
Primary Academic Need *
Secondary Academic Need
Other Academic Needs
Did you participate in any of these programs?

 

 

 

Federal Tax Information & Financial Aid:

In order to evaluate your eligibility for TRIO Student Support Services and TRIO grant aid at Vermont State University, we need your authorization to review Federal Taxpayer Information (FTI) received from the Free Application for Federal Student Aid (FAFSA).
FTI that may be utilized includes:
• Adjusted Gross Income for you and your family 
• Family Size
I authorize the financial aid office at the VTSU to participate in discussions with VTSU TRIO staff and disclose Federal Taxpayer Information through Institutional Research for the purpose of qualifying for TRIO Student Support Services. I understand that if I wish to revoke this authorization at any point in time, I must do so in writing to the financial aid office at the Vermont State University. *

This authorization is only applicable to the current financial aid year. I understand if I wish to allow staff to review FTI in future years, authorization will be required again. 

You have a right to revoke this authorization even after you grant it. If you wish to revoke this authorization, you must do so in writing.  Any revocation will not have retroactive effect and will only be effective for potential uses of FTI after the date the revocation is received.  

Important! If you do not provide authorization for the financial aid office to participate in discussions with TRIO staff and disclose Federal Taxpayer Information, it limits your ability to qualify for TRIO Student Support Services and TRIO grant aid. If you wish to change your answer, please do so above.

Confidentiality and Student Signature:

Important! Johnson Academic Support staff handle student information confidentially to assist in verifying your TRIO eligibility to the Federal Government and/or providing you with academic/personal services. Your signature below verifies your agreement with the three statements below.

1. I authorize Johnson Academic Support to obtain disability data, verify citizenship and verify my academic standing (when necessary) to either provide or initiate Student Support Services for me, and to share this application with other TRIO Student Support Services staff within Vermont State University for the purpose of providing me with the appropriate services at my location.

2. I give Academic Support permission to request feedback from my professors and I agree to meet with Academic Support staff if my professor(s) indicate that my performance is unsatisfactory.

3. I certify that the information I have provided on this application is correct to the best of my knowledge. I understand that if any of this information is found to be false, my eligibility for TRIO Student Support Services will be jeopardized.
Sign and Submit: 
Applicant's Signature
Please select a signature verification type.