APPLICATION REACTIVATION FORM

October 10, 2018

You may apply for readmission or reactivation to Vermont Tech if you are:

  • A previously matriculated student (within the last 3 years) who has not attended Vermont Tech for one term or more
  • A previously matriculated student who was academically dismissed within the last 3 years
  • An applicant within the last 2 years who did not matriculate

Completion of this form does not guarantee admission to Vermont Tech; your application and supporting documents will be reviewed prior to admission.

Please return the completed form to or return by mail to VTC Admissions, PO Box 500, Randolph Center, VT 05061.

Your Name / Type first/last name here / Student ID
Mailing Address / Type street address/PO Box here / DOB / Enter DOB here /
City, State ZIP / Type city, state, zip here /
Home Phone / Type home phone here / Cell Phone / Type number here /
Email Address / Type email here / Former Name/Alias / If none, leave blank /
Major / Select a major /
Location / Select a location /

Please transfer my application to be reviewed for:

Term: / Year / Spring ☐ Fall ☐ (Nursing, Respiratory, Dental, and Vet Tech – Fall ONLY)
☐ Full-Time ☐ Part-Time
Colleges attended since you last applied: / Type colleges attended here
Yes / No
If providing a mobile phone number, would you like important updates and reminders by text? / ☐ / ☐ /
Will you be requesting on-campus housing? (Randolph and Williston campuses only) / ☐ / ☐ /
Have you ever been subject to disciplinary action or do you currently have disciplinary charges pending by any educational institution due to academic (such as, but not limited to, cheating or plagiarism) or behavioral misconduct (such as, but not limited to, fighting or drug use)? / ☐ / ☐ /
Have you ever been convicted of, or charged with, a criminal offense or are you currently the subject of any criminal proceeding?It is mandatory that you answer this question. If not answered, we will be unable to process your reactivation. / ☐ / ☐ /
If you have selected “yes” to either of the last two questions listed above, please provide an explanation including the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.

Your Electronic Signature

Signing below becomes your electronic signature acknowledging that the information given above is accurate. Before signing this document, verify that the information you have entered is correct.