Fillable ADMISSIONS APPLICATION (Cayuga County Community College)

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ADMISSIONS APPLICATION (Cayuga County Community College)

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U.S.A. forms for Cayuga County Community College

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CITIZENSHIP STATUS  U.S.  Dual U.S. Citizen Permanent Resident  Refugee/Asylee  Other
If not U.S., Country of Citizenship _____________________________ Country of Birth ______________________________ Visa Type ___________
If you are NOT a U.S. citizen or permanent resident, please go to https://www.cayuga-cc.edu/international
ENGLISH IS MY PRIMARY LANGUAGE
Yes No
I HAVE SERVED IN THE U.S. ARMED FORCES (including Reserves or National Guard) Yes No
If yes, I PLAN TO SEEK V.A. EDUCATIONAL BENEFITS? Yes No
I WOULD LIKE INFORMATION ABOUT DISABILITY SERVICES Contact the Oce of Accessibility Resources (OAR) at
315-294-8422 (Auburn) or 315-593-9327 (Fulton) https://www.cayuga-cc.edu/cas/services/accessibility-resources/
I WILL BE A
 First-Time College Student  Transfer Student From Another College
I PLAN TO STUDY
At the Auburn Campus  At the Fulton Campus  Online Only
I AM INTERESTED IN OFF-CAMPUS HOUSING
 Yes  No
I AM INTERESTED IN ATHLETICS WOMEN’S:
 Basketball  Cross Country  Golf  Lacrosse  Soccer  Softball  Volleyball
MEN’S:  Baseball  Basketball  Cross Country  Golf  Lacrosse  Soccer
I AM INTERESTED IN DUAL ADMISSION WITH ONE OF THE FOLLOWING TRANSFER INSTITUTIONS Select one institution
LeMoyne College  SUNY Oswego     Wells College  SUNY Upstate Medical University, College of Nursing (BS in Nursing)
State University of New York
ADMISSIONS APPLICATION
Have you ever been dismissed from a college for disciplinary reasons? Yes No
How did you hear about Cayuga?  I live in the area  School counselor  High School presentation  College fair  Cayuga admissions rep.
 Cayuga mailing  Family/friend  Cayuga website  Social media  TV  Radio  Billboard
ALL APPLICANTS MUST ANSWER THE FOLLOWING QUESTIONS:
INFORMATION IN THIS BOX IS OPTIONAL It will be kept condential and used only to help you use college services. This information will not be used in
a discriminatory manner, nor will you be penalized in any way if you choose not to respond.
ARE YOU HISPANIC/LATINO?  Yes   No
If YES, check one:  Central American  Dominican  Mexican  Puerto Rican  South American  Other Hispanic/Latino
ARE YOU?  Am. Indian/Alaskan Native  Asian  Black/African American  Native Hawaiian/Other Pacic Islander  White
HIGH SCHOOL
(please use school’s formal name) ____________________________________________________ City _______________________ State __________
Current high school student/expected date of graduation (mo./yr.): ____________
High school graduate/date of graduation (mo./yr.): ________________
Home-schooled
student  
Received an IEP or CDOS diploma
GED/TASC recipient
I did not graduate or receive a GED
I earned college credit while still in high school
Yes No
I have taken / am currently taking college courses in high school through Cayuga Advantage New Visions Other
Colleges and Universities previously attended
(do not include Cayuga Community College)
Please have your academic records sent to the Admissions Oce
Name ________________________________________ City __________________________ State __________ Dates Attended ________________
Name ________________________________________ City __________________________ State __________ Dates Attended ________________
________________________________________________________________________________________________________________________
Last Name First Name M.I.
_____________________________________________________________________________________________________________________________________
Former Name/Maiden Name
________________________________________________________________________________________________________________________
Permanent Address (address where you reside when you are NOT attending school) City State Zip
_______________________________________________________________________________________________________________________________________
Local Mailing Address (address where you reside WHILE at school) City State Zip
Cell Phone ( _____) __________________ Home Phone ( _____)__________________ E-mail (Preferred Address) ___________________________________________
I have Resided in New York State as a Permanent Resident for the 12 Months Immediately Preceding this Application
Yes No
If Yes, County of Permanent Residence ________________
_______________________________________________________________________________________________________________________________________
Previous Mailing Address If You Have Resided In New York State Less Than 12 Months City State Zip
For Federal Tax Reporting Purposes Only
Social Security Number __ __ __ / __ __ / __ __ __ __
Month Date Year
MM DD YYYY
Date of Birth
_____ / _____ / ______
REQUIRED:
OFFICE USE ONLY
C# __________________________
GENDER (optional)  Female  Male
Falsifying student residence information to financially benefit from reduced tuition is residence fraud, which could result in criminal charges and restitution for the actual unpaid tuition.
SEMESTER I PLAN TO START COLLEGE Semester and Year ________________________
MY LEGAL NAME (the name that appears on your Social Security card or passport)
AW ONLINE 11-05-19
APP USER ID: APP ID:
Cayuga Community College is a unit of the State University of New York. It is the policy of the University and this College not to discriminate on the basis of sex, race, color, religion, national origin, disability, age, marital status or
sexual orientation in admission, employment, or treatment of students and employees in any educational program or activity. The information on this admission application will be used by Cayuga Community College to evaluate your
request for admission. Failure to provide the requested information could prevent your application from being processed. The authority to request this information is found in section 355(2)(i) of the Educational Law.
PLEASE COMPLETE ALL REQUESTED INFORMATION AND SIGN, MAIL OR FAX TO:
FOR MORE INFORMATION Call: 1-866-598-8883 E-mail: admissions@cayuga-cc.edu Live chat: www.cayuga-cc.edu/chat
Cayuga Community College Admissions Oce
197 Franklin Street, Auburn, NY 13021: Auburn Campus Fax: 315.283.2075 OR 11 River Glen Drive, Fulton, NY 13069: Fulton Campus Fax: 315.598.4203
SEND YOUR OFFICIAL TRANSCRIPTS OR ORIGINAL GED TO THE SAME ADMISSIONS OFFICE
SCHOOL OF HEALTH SCIENCES
Health Sciences AS*
Must check one concentration:
 Clinical Perfusion*
Chiropractic Medicine
 Medical Imaging/Radiography*
 Medical Technology & Medical Biotechnology
 Physical Therapy*
 Radiation Therapy*
 Respiratory Therapy*
Nursing – R.N. AAS*
Nursing program has a separate and selective admission
process; see catalog or website for requirements.
Occupational Therapy Assistant AAS** OTA
program has a separate and selective admission process;
see catalog or website for requirements.
SCHOOL OF MEDIA AND THE ARTS: SOMA
Audio Production AAS
Audio Production AAS
Music Production Option
Creative and Professional Writing AS
Culinary Arts AAS (Starts Fall 2020)
Liberal Arts and Sciences/
Humanities and Social Sciences AA*
Concentration oered (not required)
Literature
†
Music
Theatre
Writing
†
Media Communications AS
Concentration oered (not required)
Public Relations
Social Media Communications
Media Production AAS
Concentration oered (not required)
Broadcast Journalism
 Film and Cinema Studies
Social Media Communications
Video/Digital Film Production
Studio Art and Design AS*
Concentration oered (not required)
Ceramics
Graphic Design
Painting and Drawing*
Photography
Printmaking
 Telecommunications Technology AAS
SCHOOL OF BUSINESS
Accounting AAS
Business Administration AS*
†
Business Administration AAS*
†
Entrepreneurship
Sports Management
Wine Studies (must be 21 years of age or older)
Event and Tourism Management AAS
†
CERTIFICATE PROGRAMS
 Event Management
†
 General Business*
†
 Tourism Management
†
SCHOOL OF SCIENCE, TECHNOLOGY,
ENGINEERING AND MATH: STEM
Computer Hardware/Software Design AAS
Computer Information Systems AAS*
Computer Information Systems AAS*
Internet Technology Option
Computer Science AS*
Information Technology A.S. *
Must check one concentration:
 Creative Game Design Concentration
 Web Design Concentration
 Network Administration Concentration
 Cybersecurity Concentration
Electrical Technology – Electronics AAS
Environmental Studies AS*
 Geographic Information Systems AS
Liberal Arts & Sciences/Mathematics AS*
Liberal Arts & Sciences/Mathematics and
Science AS*
†
Concentration oered (not required)
Biology
†
Chemistry
Geology
GIS (Geographic Information Systems)
Mechanical Technology AAS
Plastics Technology Option
Mechanical Technology AAS
Must check one concentration:
Computer Aided Design (CAD)
Facilities Design
Mechatronics
Precision Machining
CERTIFICATE PROGRAMS
Advanced Manufacturing
Computer Hardware/Software Design
Computer Information Systems*
Electronics
Plastics Manufacturing
Industrial Maintenance Technology**
SCHOOL OF SOCIAL SCIENCES AND EDUCATION
Criminal Justice – Corrections AAS*
†
Criminal Justice – Police AAS*
†
Early Childhood AAS
Liberal Arts and Sciences/
Adolescence Education AA*
Must check one concentration:
 Biology
Chemistry
Earth Science
English
History/Social Studies
Mathematics
Liberal Arts and Sciences/Childhood Ed. AA*
Must check one concentration:
English
General Science
History/Social Studies
Liberal Arts and Sciences/
Humanities and Social Sciences AA*
†
Concentration oered (not required)
Criminal Justice*
†
Early Childhood
Education*
History*
Psychology*
†
CERTIFICATE PROGRAMS
 Early Childhood
*
This degree program can be completed at either
campus. Select concentrations available in Fulton.
** This degree program can be completed in Fulton only.
†
This degree program can be completed online.
Select concentrations available online.
PARENT / GUARDIAN INFORMATION if you are under 19
_______________________________________________________________________________________________________________________________________
Father’s full name Address Phone E-mail
_______________________________________________________________________________________________________________________________________
Mother’s full name Address Phone E-mail
_______________________________________________________________________________________________________________________________________
Emergency contact name Address Phone
I certify that the information on this application is complete and accurate. I understand that this application cannot be processed if it has not been completed according to its
instructions, and that any deliberate falsification or omission of data could result in denial of admission or dismissal from the college.
APPLICANT SIGNATURE _______________________________________________________________________ DATE _____________________
AW ONLINE 11-05-19
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ADMISSIONS APPLICATION (Cayuga County Community College)

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Completed 26 July 2020

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