Thank you for your interest in our TRIO Student Support Services program at Randolph and Williston!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  If you have any questions, please call us at: 802-728-1396 (Randolph) / 802-879-2329 (Williston).

Please note: You are not eligible to apply if you (a) already have a 2 or 4 year degree, and/or (b) you are in a degree program without an Associate option (Pilot Technology, Manufacturing Engineering, Renewable Energy).
Student Information
Last Name: *
First Name: *
Middle Initial:
Preferred Name:
Date of Birth (xx/xx/xxxx): *
School Email Address: *
Student ID: *
Cell Phone Number:
May we text you periodically with reminders and timely information to support your success?
Campus Location *
Do you already have a 2 or 4 year college degree? *
VTSU Academic Support is funded in part by a TRIO grant from the U.S. Department of Education. This grant enables us to provide additional academic support services to students who are 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 and Financial Information
With whom do you live (or, if independent, whom did you live with at age18)? *
What is the highest level of education completed by either parent (biological or adoptive)? *
Ethnicity:
Are you a U.S. citizen?
Have you applied for Financial Aid? *
Did you receive a Pell Grant? *
Academic Information
Do you have a documented disability? *
Program of Study:
Institution Start Date: *
Anticipated Graduation Date:
Please describe at least two 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.
Sign and Submit: 
Applicant Signature *
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Signature: (Type in your full name)
I agree to the terms included.

Confidentiality and Student Signature:

Important! Randolph 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 Randolph 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.