Revised 2/6/2018
Newburgh Campus
1 Washington Center, Newburgh, NY 12550
Middletown Campus 115 South Street, Middletown, NY 10940
(845) 341-4140 ●
Permission to Attend
Another Institution
Student Name: ____________________________________________________ A#: _____________________
E-mail: Phone Number: _____________________
Current Program of Study: ___________________________________________________________________
Advisor Name: _____________________________________________________________________________
It is SUNY Orange’s policy to only transfer in credits that are applicable to the student’s current degree or intended
degree (in the case of our health profession programs). This is the only way to guarantee the course(s) will be applied
towards your current program of study.
Please note, a maximum of 30 transfer credits total may be applied towards your SUNY Orange Degree. Only courses in
which the student has received a grade of at least “C” will be considered. Courses and credits (but not grades) are
accepted. Transfer credits do not affect the cumulative SUNY Orange GPA.
Please be advised that this form does not replace the SUNY Cross Registration Form. If your intent is to be a Cross
Registered student you must submit the official SUNY paperwork.
Name of other college you are requesting to attend: __________________________________________________
Other College Course Information
SUNY Orange Equivalent Information
Course Number
Course Title
Course Number
Before registering at another institution this form needs to be filled out and approved by the Registrar’s Office. If it is
approved, you will receive a copy of the approved form from the Registrar’s Office via your SUNY Orange E-mail.
Students must submit Official Transcripts no later than the end of the following semester after the coursework was
Student Signature: _______________________________________________________________ Date: ______________
Advisor Signature: _______________________________________________________________ Date: ______________
Registrar Signature: ____________________________________________ Date Permission Granted: _______________
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