Vermont Tech, Administration building, Randolph Center campus, trees

Non-Degree Registration Form

Please complete this form to register for courses as a non-degree student. If you have questions, please contact the Registrar's Office at 802-728-1302 or registrar@vtc.edu.

Term (Fall, Spring, Summer)

Fall

Spring

Summer

Term Year

First Name

Middle Name

Last Name

Student ID (if known)

Phone

Phone Type

Home

Mobile

Work

Email Address

Country

Street

City

Region

Postal Code

Demographic Information

Social Security Number

Date of Birth

Student Status

First College Course

Returning Student

High School/Dual Enrollment

Transfer Student

Other

Please Describe

Gender

Male

Female

Citizenship

Non-resident alien

Resident alien

Other Country

Citizenship Country

Are you Hispanic or Latino

Yes

Race (to select more than one hold down the ctrl key while selecting)

Are you a Vermont resident?

Yes

Please list your state of residency

Are you a current high school student?

Yes

High School Name

High School State

Authorization for Release of Information to a School or Agency:

In accordance with the Family Rights and Privacy Act of 1974, as amended, this form constitutes written consent from the student to disclose personally identifiable information from their record to the party listed below for the purposes specified. The receiving party is cautioned that this information may not be released to any other parties without written consent of the student.

When participating at Vermont Technical College through the Dual Enrollment program, I hereby grant permission to Vermont Tech to share information related to my enrollment, attendance, and performance with my High School Principal or their designee. I understand that an official Vermont Tech transcript will be issued to my high school after final grades have been received.

Name of School Designee

School Email Address

School Phone Number

High School or GED Graduation Year

High School Graduate

Yes

GED

Are you a veteran

Yes

Are you applying for VA benefits

Yes

Which program/chapter are you applying under

How will you be paying for the course(s)?

I am using a Vermont Dual Enrollment Voucher

Bill my high school directly

I will be submitting a check

Vermont Dual Enrollment Voucher Number

Initial

If you will require physical, psychological, or learning disabilities services please contact our office of Disability Services, at (802) 728-1278.

Course Registration

Course Section & Number

Course Title

Campus Location/On-Line

Credits

Course Section & Number

Course Title

Campus Location/On-Line

Credits

Course Section & Number

Course Title

Campus Location/On-Line

Credits

Statements of Understanding

A. The College reserves the right to make changes in course offerings, charges, regulations, and procedures as educational and financial considerations require.

Initial

B. I agree that if this account is not paid when due, I agree to pay all costs of collections including interest, attorney’s fees and collection agency fees, and other costs related to the collection of my account.

Initial

C. I understand that providing false information on this registration form could result in denial of admission to courses or, if already admitted, expulsion from the College.

Initial

D. In accordance with Vermont Statutes Annotated, Title 16, Statute 176, Section 1 (C): I understand that credits earned at the Vermont State Colleges are transferable only at the discretion of the receiving school.

Initial

Family Educational Rights and Privacy Act

The Family Educational and Privacy Act (FERPA) is a federal law designed to protect the privacy of student educational 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 educational records maintained by the college. If parents/guardians claim a student as a dependent, they may have access to the student’s educational records without prior written consent. Students have the right to request that the college correct academic records believed to be inaccurate or misleading. If the college decides not to amend the record, the student then has the right to a formal hearing. After the hearing, if the college still decides not to amend the record, the eligible student has the right to place a statement with the record commenting on the contested information in the record.

Generally, the college must have written permission prior to releasing any academic information from a student’s record. However, the law allows the college to disclose records without consent, to the following parties:

• College employees who have a need to know;
• Other schools to which the student is applying;
• Certain government officials in order to carry out lawful functions;
• Appropriate parties in connection with financial aid to a student;
• Parents of dependent eligible students;
• Organizations conducting studies for the college;
• Accrediting organizations;
• Individuals who have obtained court orders or subpoenas;
• Persons who need to know in cases of health and safety emergencies; and state and local authorities, within the justice system, pursuant to specific state law.

Students have the option of completing an online form in Web Services that provides parents or others with access to their academic records and an access code for them to provide when seeking information either in-person or on the phone. This access does not include transcript requests, grade reports or enrollment verifications; these must be individually requested by the student.

Directory Information

The college may also disclose, without consent, “directory type information” that is considered not to be harmful to student/parent if released. The information considered by the college to be directory information is name, home and college address, telephone listing, email address, date of birth, major, enrollment status (full-time or part-time), enrollment level (undergraduate or graduate), dates of attendance, degrees and awards received, weight and height of athletic team members, photographs, most recent and previous educational institutions attended, and participation in officially recognized activities and sports. Parent information is not directory information.

Students have the right to withhold the release of any or all directory information, to do so a written request must be made at the Office of the Registrar.

For additional information or to file a complaint, you may contact the Family Policy Compliance Office at (202) 260-3887 or om@ed.gov or US Department of Education, 400 Maryland Ave, SW, Washington, DC 20202-4605. Revised: 3/1

Acknowledgements & Signature

Students receiving payment from a third party or voucher payments after grades are released should contact the Business Office at 802-728-1301 to see if you are eligible to defer your payment.

High school students must have a voucher, approval letter from their school and/or take placement.

I understand as a non-degree student I am not eligible for Title IV Federal Financial Aid. (In order to be considered for Title IV federal aid, students need to be enrolled at least half time or 6 credits and matriculated into a degree program.)

I certify that I have read and acknowledge the statements on form and that all information provided by me is correct.

Yes

Signature

Date