STUDENT APPLICATION FORM  
PERSONAL INFORMATION   
Name _ 
Date of Birth (mm/dd/yyyy) 
Gender:
 
Phone (Home)
 (Cell)  
Email
 
Mailing Address 
 
Physical Address
 
HIGH SCHOOL INFORMATION  
High School
 
GPA
 
SAT Scores: Reading/Writing 
 Math 
 
ACT Scores: English or English/Writing 
 Math
 
Counselor’s Name _
 
Counselor’s Signature 
 
ADMISSIONS INFORMATION 
Have you applied to UVI?  
 Yes  No 
Have you been accepted to UVI?    Yes      No 
Do you plan to attend UVI?      Yes     No 
If you plan on attending another college, please name that college 
 
MEDICAL/DISABILITY INFORMATION  
List chronic or specific medical problems or allergies:  
 
List medications you are currently taking:  
 
EMERGENCY INFORMATION  
In case of an emergency, list the person(s) to be notified:
 
Relationship with the applicant 
Phone: (home) 
(cell)_ 
(work)_
 
Email:  
Student’s Signature  
Date
 
Parent’s/Guardian’s Name 
 
Parent’s/Guardian’s Signature 
 Date 
 
Center for Student Success 
      Summer Bridge Program 2023 
 
Center for Student Success                                                        Summer Bridge Program 2023  
 
APPLICATION AND SELECTION PROCESS  
  
Application Form and Support Documents  
 
Complete and submit the application form and other support documentation. Application 
support documentation includes a personal statement and transcript. Submit all documents 
together.   
  
Criteria for Personal Statement:  
 
Submit a typed double-spaced, size 12 fonts, Times New Roman, 300-500 words essay based on 
the following question: “What influenced you to be a part of the 2023 Summer Bridge 
program?”   
 
Criteria for Application Admittance:   
 
You will be eligible if:  
• 
Your application is complete and legible  
• 
You meet the academic criteria for participating in Bridge (SAT individual scores:    
Math – beginning at 390 and less than 520, and Reading/Writing – starting at 400 but less 
than 560  
or ACT individual scores: Math – beginning 18 but less than 20, and English or 
English/Writing above beginning 19 but less than 21)  
• 
Your statement meets the criteria above). (Decisions made by the Summer Bridge team 
are final)  
• 
A $25 program fee will be collected once you are accepted into the program  
  
The application deadline is May 30, 2022.  
  
Submit completed applications and support documentation by email (mflemin@uvi.edu) or 
in person.  
  
Dr. Maria Fleming   
Assistant Director of the Center for  
Student Success/ Director of Summer Bridge   
RR 1 Box 10,000   
Kingshill, St. Croix   
U.S. Virgin Islands  00850-
9781 mflemin@uvi.edu or 
css@live.uvi.edu