Fill - Free fillable Course Credit RegistrationForm StudentInformation SSNorTaxIdentificationNumber* (Orange County Community College) PDF form

Credit

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Course

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RegistrationForm

NewburghCampus

1WashingtonCenter,Newburgh,NY12550

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MiddletownCampus

115SouthStreet,Middletown,NY10940

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(845)341‐4140●registrar@sunyorange.edu

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StudentInformation

Semester:______FALL______WINTER______SPRING_______SUMMER

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TermofLastRegistration:Semester__________Year_______________

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LastName___________________FirstName______________________MiddleInitial___

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A#___________________________

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SSNorTaxIdentificationNumber*

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_____________________________

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StreetAddress______________________________________________________

City__________________________________State______ZipCode___________

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*SSNorTaxIdentificationNumberis

requiredbytheIRSforreportingof

tuitionandrelatedexpensesfortax

purposesandforfinancialaid.

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Sex:MaleFemale



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HomePhone________________________CellPhone__________________________

___

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EmailAddress:_______________________________________________

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CountyofResidence 

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_________________________________

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_____________________________________________

DateofBirthMM/DD/YYYY(Mandatory)

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OtherNamesUsed:__________________________________________

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EmergencyContact:

Name:_______________________

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Phone#:_____________________

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RelationshiptoYou:____________

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U.S.CITIZEN______YES_______NO

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IFNO(Checkone)

_________PERMANENTRESIDENTALIEN

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______NON‐RESIDENTALIEN(identifybelow)

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WhatCountry?__________________________

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VeteranStatus:

________VET

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________DependentofVET

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________ActiveDutyMilitary

AreyouHispanic/Latino?_______Yes_______No

IfHispanic/Latino,isyourbackground?(selectone)

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_______CentralAmerican_______Dominican_______Mexican

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______PuertoRican_______SouthAmerican

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______OtherHispanic/Latino

Allstudents,pleaseindicateyourrace.(selectoneormore)

____White____Black____Asian

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____AmericanIndian/NativeAlaskan

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____NativeHawaiian/PacificIslanderEthnicity:

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NameofotherCOLLEGE(s)attended(upto2)

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AreyouaHighSchoolGradorGEDRecipient?

Yes_______No_________

NameofHighSchool___ ___________________

Continuetonextpage

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_______

Degree Seeking

Non Degree Seeking________

Visiting Students:

SUNY College ______________________

Non SUNY College __________________

FOROFFICEUSEONLYDATE:_______INITIALS:_____

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LastUpdate10/22/2019

CourseRegistrationDetails

1. Youareobligatedtopayinfullalltuitionandfeeswhetherornotyouattendclassesunlessyouofficiallydropclassesin

accordancewiththerefundschedulepublishedontheStudentAccountswebpage

http://www.sunyorange.edu/studentaccounts

2. Someofyourfinancialaidawardsmaybereducedorcancelledif:(1)Youregisterforcoursesthatarenotapplicableto

yourdegreerequirementsor;(2)Changefromfull‐timetopart‐timestatus.

3. Iunderstandthatifmyimmunizationrequirementsarenotmet,Imaybedropped

frommyclasses.

4. IamawareoftheSUNYOrangecourseprerequisite/co‐requisitepolicyasoutlinedinourcatalogforeachcourse.

5. Iunderstandthatsomecoursesareofferedatmultiplelocations(Middletown,Newburgh,Online,etc.)andmyscheduleof

sectionshastakenthatinformationintoconsideration.

ProgramofStudy:

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CRN

SUBJECT COURSE SECTION CAMPUS COURSETITLE CREDITS

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   

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   

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   

Total

Credits

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   

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IacceptfinancialresponsibilityformySUNYOrangebillduringtheindicatedsemester.Iacknowledgethatmytuitionandfeesmustbepaidby

theduedateorIwillbeassesseda$50.00latepaymentfee.Irealizethatnon‐attendancewillnotrelievemyfinancialresponsibility.

IhavereadandunderstandtheSUNYOrangerefundpolicyandNYSresidencyrequirements.Iunderstandthatifacollegedebtisreferredto

outsidesourcesforcollection,Iwillberesponsibleforpayingadditionalcollectioncontingencyfees(upto50%ofthedelinquentaccount

balance).IunderstandthatIwillberestricted

fromregisteringforadditionalcoursesorforfuturetermsandmytranscriptsanddiplomaswill

beplacedonhold.

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*PleasenoteyoumustcompletetheSICASAcceptChargesSurveybyloggingintoyourMySUNYOrangeaccount.

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Course Credit RegistrationForm StudentInformation SSNorTaxIdentificationNumber* (Orange County Community College)

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