Fillable COLLEGE ADVANCEMENT PROGRAM STUDENT APPLICATION (State University of New York College at Potsdam)

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COLLEGE ADVANCEMENT PROGRAM STUDENT APPLICATION (State University of New York College at Potsdam)

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The COLLEGE ADVANCEMENT PROGRAM STUDENT APPLICATION (State University of New York College at Potsdam) form is 2 pages long and contains:

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  • 12 check-boxes
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File type: PDF

U.S.A. forms for State University of New York College at Potsdam

BROWSE STATE UNIVERSITY OF NEW YORK COLLEGE AT POTSDAM FORMS

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Please complete, print, and fax to 315.267.3350 or mail to Graduate & Continuing Education, 44 Pierrepont Ave., Potsdam, NY 13676-2294
Updated: Aug 2017
www.potsdam.edu/earlycollege Phone: 315.267.2165
COLLEGE ADVANCEMENT PROGRAM STUDENT APPLICATION
Semester you are applying for:
Summer
Fall Winterim
Spring
Year
Date:
Name (F M L):
Mailing Address:
City/State/Zip:
E-mail Address:
SS or "P" Number:
Date of Birth:
Are you a veteran or a
dependent of a veteran?
Are you a U.S. Citizen?:
yes
no
yes
no
Male
Female
Home Phone (MA):
Cell Phone
(ZY)
:
Are you Hispanic/Latino?
If yes, select one:
yes no
Principal resident of
New York State?
yes no
If yes, # of years:
Central American Dominican Mexican
South American
Puerto Rican
Cuban
Other Hispanic/Latino
Please indicate your race (select one or more):
White
(1)
Black or African American (2)
Asian (3)
Native Hawaiian or Other Pacific Islander (4)
American Indian, Alaska Native, or First Nations (5)
HIGH SCHOOL INFORMATION:
Name of High School:
Location (City/ST):
Have you ever attended SUNY Potsdam?
Expected Graduation (Mth Yr):
Briefly describe your reason for attending SUNY Potsdam.
Briefly describe your current educational status.
*If you attended SUNY Potsdam previously under a different name, please indicate that here.
no yes*
If yes, last semester enrolled
Check here if you have been:
convicted of a felony
dismissed from a college for
disciplinary reasons
List all secondary schools and colleges attended, beginning with the most recent, and include date(s) of attendance.
School Name
City ST Zip
Dates Attended
Total Credits
GPA
I declare that I have not been "dismissed" and I am eligible to return to, or graduate from, the college(s) and/or high school(s) listed on my
SUNY Potsdam College Advancement Program Student Application. I understand that
official transcript(s) must be sent by all
college(s)/high school(s)
in question and received by the first day of the semester or I may be dropped from the class(es).
Applicant's Signature Date
INTERNATIONAL STUDENTS ONLY:
Please complete the following
Country of Birth:
Country of Citizenship:
State of Legal Residence:
If not a U.S. Citizen, have you
applied for citizenship?:
yes
no
If yes, how many yrs have you been in U.S.?
If not a U.S. Citizen, indicate
your visa type:
J-1 Exchange (72)
Visa Expiration (Mth Yr):
click to sign
signature
click to edit
Please complete, print, and fax to 315.267.3350 or email to earlycollege@potsdam.edu
www.potsdam.edu/earlycollege Phone: 315.267.2926
COLLEGE ADVANCEMENT PROGRAM STUDENT
COURSE REGISTRATION FORM
Registration Date:
Semester:
(Date you are submitting your request)
Summer Fall Winterim Spring
Year
Name
First Middle Last
Potsdam ID or
SS Number:
Mailing Address: Home Phone:
City/State/Zip: Cell Phone:
Email Address:
Please Note: Non-matriculated undergraduate students (including College Advancement Program high school students)
are restricted to no more than 8 credits per semester and 15 credits per year.
Course Code
Example: 10090
Course Number
Example: CHEM 101
Section Number
Example: 089
Course Title
If available
Credits
Example: 3
Please Note: Preference in courses is given to SUNY Potsdam matriculated students. To support this effort, non-matriculated students will
not be enrolled in any courses until one week prior to the start of the semester, unless permission is granted by the professor. In the case
of a course meeting max enrollment capacity, you may be bumped from said course if a matriculated student needs to take it.
Please complete this fillable PDF form and return to Office of Early College Programs:
By Email:
earlycollege@potsdam.edu
By Fax:
315.267.3350
By Mail:
Graduate & Continuing Ed
206 Raymond Hall
44 Pierrepont Avenue
Potsdam, NY 13676
In affirming its commitment to equality for all individuals, SUNY Potsdam has an affirmative action program which actively seeks faculty,
staff, and students without regard to race, color, religion, sex, age, marital status, national origin, or physical handicap.
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COLLEGE ADVANCEMENT PROGRAM STUDENT APPLICATION (State University of New York College at Potsdam)

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Completed 27 August 2020

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