Course Audit
Registration Form
Registrar’s Office, SUNY Plattsburgh, Kehoe Administration Building Rm. 304, 101 Broad Street, Plattsburgh, NY 12901
Telephone: 518-564-2100 -- FAX: 518-564-4900 Email: registrar@plattsburgh.edu
Policy: Students, faculty, staff, and community members may audit most courses on a space-available basis if they have the permission of course instructors, complete this form,
and pay a non-refundable registration fee of $50 (exemptions listed below) and any applicable course-specific, technology and college fees. Persons who audit shall attend courses
without working for or expecting to receive a grade or formal credit. The following types of courses may not be audited: practicum courses; internships; research and independent
study courses; field courses; clinical courses; workshops; on-line/hybrid courses; and study away courses and programs.
_______________________________________________________________________________________________________________________________________________
PERSONAL INFORMATION (Please Print).
Name: _________________________________________________________________ Date of Birth: ______________
Last First M. mm/dd/yyyyy
Home Address: __________________________________________________________________________________________________________________________________
Street City State ZIP
Email Address: ____________________________________________________ Daytime Phone: ________________________ Evening Phone: ____________________
Gender:
Male Female
Are you a senior citizen (60 or over)
Yes No Have you ever been separated from a college for disciplinary reasons? Yes No
Are you a SUNY Plattsburgh (check all that apply): Are you a U.S. Citizen?
Yes No
Matriculated Student
Yes No If yes, have you been a permanent NY resident for the last 12 months? Yes No
Alumnae Yes No If no, list the country of your citizenship: _________________________________________________
Employee
Yes No
Immediate Family Member of Employee
Yes No
Voluntary Demographic Data (circle one or more):
American Indian or Alaskan Native (I) Black or African American (B)
Asian (A) White (W)
Native Hawaiian or Other Pacific Islander (P)
Are you Hispanic/Latino? Yes No If Hispanic/Latino, is your background (check one):
Central American Mexican South American
Dominican Puerto Rican Other Hispanic/Latino
COURSE INFORMATION
Semester you would like to audit course (circle one): Fall Winter Spring Summer Year: ______________________________
CRN _________ Course Subject __________ Course Number _____________ Course Section ___________ Campus Location : Main Branch
REQUIRED SIGNATURES:
Course Auditor: ____________________________________________________________________________ Date: _____________________________
Instructor of Course: ___________________________________________________________
Approve Disapprove Date: _____________________________
Chair of Department Offering the Course: __________________________________________
Approve Disapprove Date: _____________________________
A $50 course audit fee applies (exemptions: senior citizen, SUNY Plattsburgh matriculated student, alumnae, retiree, employee, and immediate family member of employee).
Course-specific, technology, and additional college fees may apply to course audit registrations.
Registrar’s Signature: _________________________
Fee Required Exempt Fee Waived Notification to Student Accounts: _________
rev. 04-2020
Indicate Approval in Email
Indicate Approval in Email
click to sign
signature
click to edit
![]()
