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 is the biggest academic obstacle you are currently facing?  Please check all that apply.
Failing Grades
Lack of academic preparedness for college level course work
Lack of educational and/or career goals
Limited English Proficiency
Low Admission/SAT/ACT test scores
Low college grades
Low high school grades
Need for academic support to raise grade(s) in required course(s)/major
Out of the academic pipeline for 5 or more years
I have a GED
Did you participate in any of these programs?

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, obtain financial aid documents, verify citizenship and verify my academic standing (when necessary) to either provide me with or initiate Student Support Services.

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.

Some students may be eligible for additional programs and services, including TRIO grants of $1,000 - $2,000 and other scholarships.  If you would like to be notified about our TRIO grants, be sure to go back and check the box to allow us to text you!
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Applicant's Signature
Please select a signature verification type.