Master of Science in Clinical Mental Health Counseling Virtual Information Session

Share a little about yourself

First (Given) Name *

Middle Name

Last (Family) Name *

Name of Use (if different from First (Given) Name above)
This is the name we will use in both email and mailed correspondence with you.

Email Address *

Birthdate *
Used to ensure we don't have a duplicate record in our system.

Phone Number

Mobile Phone Number

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Yes

No

Mailing Address *

Country

Street

City

Region

Postal Code

Your Parents/Guardians

We would like to reach out to your parent/guardian with information about Vermont State University. We invite you to share your parent's or guardian's contact information below.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Second Parent/Guardian

I would like to share a second parent/guardian's information.

Other Parent/Guardian First Name

Other Parent/Guardian Last Name

Other Parent/Guardian Email Address

Your educational goals

My goal is to attend in: *

Vermont State University will offer programs to further your knowledge. What is your planned next step in your education? *

Undergraduate (pursuing an Associate degree, Bachelor degree, or certificate)

Graduate (pursuing a post-Bachelor degree or certificate)

I am a prospective:

My goal is to study:

I am a prospective:

I would like to study towards a:

Bachelor's Degree

Associate Degree

Undergraduate Certificate

My goal is to study:

This program is offered at the following campus/es:

Vermont State University Castleton

Vermont State University Johnson

Vermont State University Lyndon

Vermont State University Randolph

Vermont State University Williston

Vermont State University Killington

Vermont State University Online

Vermont State University Additional Site Location/s

Current or most recent high school attended

School Name

Current or most recent college attended

School Name

Degree Obtained *

Dates Attended

From

To

UG Level of Study (hidden)

GR Level of Study (hidden)

Varsity Athletics

Are you interested in playing varsity sports?

Yes

No