Registration
Contact Information
First Name
Last Name
Email - Please use the same email address throughout the registration process.
Please re-enter your email.
Match?
Do you live in the United States?
Yes
No
US State/Zip
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code/Postal Code
Permanent Phone Number
Mobile Phone Number
Local Phone Number
Social Security Number
Do you have a social security number
Yes
No
Please enter your social security number
This data will be encrypted and not shared. This information is used to provide secure access to University software and services required for this course, ensure that all your UVM records are kept together, and improve your overall experience across all of UVM.
Company Information
Organization
Enter n/a if not applicable
Title
Enter n/a if not applicable
If you have a UVM NetID, please enter below.
Past UVM students have a Net ID. A 'Net ID" is a UVM identifier that combines your first initial and last name. E.g. for "Joe Thompson" the net id would be "jthompso"
Highest Level of Education Completed
For research purposes only
How did you hear about this program?
Please select...
Referral from a friend/family member
Google/Search Engine
Email
Newspaper
Web Article
UVM Website
UVM Alumni
UVM Current Student
Social Media
Other
Please tell us the "Other" way you heard about this program.
Digital Marketing Bundles
Please select the three courses you would like to take as part of the Strategy and Planning Digital Marketing Certificate.
DMI Course 1
DMI Course 2
DMI Course 3
DMI
Yes
Student
Yes
Navigator
Yes
Digital Storytelling
Yes
MindEdge
Yes
Pathstream
Yes
Dietary restrictions?
If you have dietary restrictions, please list below.
We want to serve you a meal that meets your dietary needs
Certificate Option
Are you interested in pursuing the GIS Professional Certificate?
Please select...
Yes
No
Need More Info
MCAT
Are you taking the self-paced or in-person class?
Please select...
Self-paced
In-person
When would you like to receive access to the online MCAT prep program?
Date must be after the 20th of the current month
IREMS
Students with affiliation, please enter your Vermont EMS Service License number:
Please check below to indicate your agreement with the release and waiver of liability
I agree to the release and waiver of liability below.
RELEASE AND WAIVER OF LIABILITY: As a condition of accompanying rescue personnel on fire apparatus or ambulances, I hereby acknowledge and assume full responsibility for any physical injuries and/or other damage(s) that may occur while I am a voluntary occupant in such vehicles or while I am at the scene of any emergency or non-emergency situation with rescue personnel. I fully understand that when rescue personnel dispatches equipment in response to a fire, rescue or other crisis call that it means that rescue personnel are responding to a potentially hazardous situation which may result in my (or, in the case of a passenger between the ages of 16 and 18, my child's) exposure to known and unknown hazards. I understand that this includes exposure to and/or use of Fire apparatus/ambulance equipment that may break, malfunction or be used improperly by the operators of that equipment. I agree to immediately and fully obey all lawful requests and commands of the fire apparatus/ambulance organization leader and shall not participate in any medical treatment or care unless specifically requested by the assigned leader. I also understand that I may be exposed to certain confidential information. Accordingly, I will not reveal the identity of individuals, discuss the incidents with third parties or write about the incidents without the express written consent of the officers of the fire apparatus/ambulance organization. I agree to hold UVM, the fire apparatus/ambulance organization, and its officers, employees, and agents free and harmless from any liability, claims, suits or damages of whatever kind or nature that may be occasioned by the above-described events and waive any right of subrogation I may have. Such release shall not apply if liability for injury or damage arises from the gross negligence of UVM, the fire apparatus/ambulance organization or their officers, employees, and agents.
Hidden
Program Code
Please select...
BEER
CANB
DM
MCAT
DOULA
FARM
IREMS
LM
PM
GIS
DMI
DMSPE
DMSM
DMAN
DMSS
this determines whether the program-specific sections appear
elevate search value
aventri id
interest area
Anchor
Todays date
SSN
Yes
No
term
! When you click "Next" you are
NOT
registered yet !
You have completed step one of the process.
You must still select a registration option and complete the registration in our non-credit registration system.
Help with this form