Direct Admissions Enrollment Form Step 1 of 2 50% Name* First Middle Last Date of Birth* CCV ID Number (If Available)Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Phone Number*Which Vermont State College do you plan to transfer to after graduating from CCV?*Castleton UniversityJohnson State CollegeLyndon State CollegeVermont Technical CollegeAnticipated CCV Graduation*Spring 2017Summer 2017Fall 2017Spring 2018Summer 2018Fall 2018Spring 2019Summer 2019Fall 2019 Which major do you plan to pursue at Castleton University?*AccountingBusinessChemistryCommunication - Digital MediaComputer Information SystemsCriminal JusticeEnvironmental ScienceGeologyGlobal StudiesGraphic DesignHealth ScienceHistoryMathematicsMultidisciplinary StudiesPsychologySocial WorkSports AdministrationStudio ArtWhich major do you plan to pursue at Johnson State College?*Business, Accounting (Campus)Business, Accounting (Distance)Business, Hospitality & Tourism Management (Campus)Business, Hospitality & Tourism Management (Distance)Business, Management (Campus)Business, Management (Distance)Business, Marketing (Campus)Business, Marketing (Distance)Business, Sport Management (Campus)Business, Sport Management (Distance)Business, Social Entrepreneurship (Campus)Business, Social Entrepreneurship (Distance)Wellness & Alternative Medicine (Campus)Wellness & Alternative Medicine (Distance)ArtStudio ArtsAnthropology & Sociology, Criminal JusticeAnthropology & SociologyHealth Sciences, Health & Exercise ScienceHealth Sciences, Pre-Physical TherapyWhich major do you plan to pursue at Vermont Technical College?*Applied Business ManagementBusiness Technology & ManagementComputer Information TechnologyComputer Software TechnologyEntrepreneurshipManufacturing Engineering TechnologyRenewable EnergyAfter transferring, do you plan to enroll full time or part time?*Full TimePart TimeAre you interested in housing?*YesNoYou indicated interest in Vermont Technical College. Which Location?*Randolph CenterWillistonBy submitting this form, I understand that I have electronically signed this document and that: • Guaranteed admission via the vscs Direct Admissions program is contingent upon my graduation from the Community College of Vermont in the term indicated on this enrollment form as well as my successful completion of the courses set forth by the applicable transfer map, and any program specific requirements described on the applicable transfer map, • Upon graduation from CCV and successful completion of my applicable transfer map, I will be immediately admitted to the applicable program and school for the first available starting semester of the applicable program. • The Vermont State College System maintains a single student information 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, • 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 his/her education record to the applicable transfer institution within the Vermont State Colleges system, and • All Vermont State Colleges reserve the right to deny or rescind admission for reasons related to school safety. By submitting this form, I certify that all of the information I have included on this form is accurate and complete. I understand that withholding information requested in this form or giving false information may make me ineligible for admission to or continuation at a Vermont State College institution.