Virginia Military Institute Lexington, Virginia 24450-0304 Click here to view VMI’s Non-Discrimination Statement.
College Report
A copy of this form must be submitted from ALL colleges you have attended since graduating from high school in addition to OFFICIAL
transcripts from those institutions. Please take the following steps so that the proper information is received in a timely manner: Step 1: e
applicant should complete the top portion of this form completely. Step 2: Give this form to the dean of the college or other individual who
has access to your disciplinary record and ask them to complete the bottom portion of this form.
Last Name First Name Email Address
Mailing Address City State Zip
Dates of Attendance at this Institution
By signing this form I grant permission to the designated representative of ________________________________________________
Name of Institution
to complete this form and provide the information requested.
Signature Date
Please complete the information requested below and submit this form to:
Oce of Admissions, VMI
309 Letcher Avenue
Lexington, VA 24450
1. Has the above named student ever been involved with any disciplinary incident that resulted in probation, suspension or dismissal from
your institution? ___ Yes ___ No
2. Has the above named student ever been involved with any incident that gives you reason to doubt this students honesty or ability to work
under an Honor System? ___ Yes ___ No
If the answer to either question above is “Yes” please attach a separate sheet explaining your response and provide any supporting documentation.
College Ocial’s Name __________________________________________________________________________________
Please Print or Type
Signature ________________________________________ Date _______________________________
Title ____________________________________________ Phone # _____________________________
Email Address ____________________________________
is form should be submitted via mail or uploaded to our secure site:
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