Credit
Course
RegistrationForm
NewburghCampus
1WashingtonCenter,Newburgh,NY12550
MiddletownCampus
115SouthStreet,Middletown,NY10940
(845)3414140●registrar@sunyorange.edu
StudentInformation
Semester:______FALL______WINTER______SPRING_______SUMMER
TermofLastRegistration:Semester__________Year_______________
LastName___________________FirstName______________________MiddleInitial___
A#___________________________
SSNorTaxIdentificationNumber*
_____________________________
StreetAddress______________________________________________________
City__________________________________State______ZipCode___________
*SSNorTaxIdentificationNumberis
requiredbytheIRSforreportingof
tuitionandrelatedexpensesfortax
purposesandforfinancialaid.
Sex:MaleFemale

HomePhone________________________CellPhone__________________________
_
___
EmailAddress:_______________________________________________
CountyofResidence
_________________________________

_____________________________________________
DateofBirthMM/DD/YYYY(Mandatory)
OtherNamesUsed:__________________________________________

EmergencyContact:
Name:_______________________
Phone#:_____________________
RelationshiptoYou:____________
U.S.CITIZEN______YES_______NO
IFNO(Checkone)
_________PERMANENTRESIDENTALIEN
______NONRESIDENTALIEN(identifybelow)
WhatCountry?__________________________
VeteranStatus:
________VET
________DependentofVET
________ActiveDutyMilitary
AreyouHispanic/Latino?_______Yes_______No
IfHispanic/Latino,isyourbackground?(selectone)
_______CentralAmerican_______Dominican_______Mexican
______PuertoRican_______SouthAmerican
______OtherHispanic/Latino
Allstudents,pleaseindicateyourrace.(selectoneormore)
____White____Black____Asian
____AmericanIndian/NativeAlaskan
____NativeHawaiian/PacificIslanderEthnicity:
NameofotherCOLLEGE(s)attended(upto2)
AreyouaHighSchoolGradorGEDRecipient?
Yes_______No_________
NameofHighSchool___ ___________________
Continuetonextpage
_______
Degree Seeking
Non Degree Seeking________
Visiting Students:
SUNY College ______________________
Non SUNY College __________________
FOROFFICEUSEONLYDATE:_______INITIALS:_____
LastUpdate10/22/2019
CourseRegistrationDetails
1. Youareobligatedtopayinfullalltuitionandfeeswhetherornotyouattendclassesunlessyouofficiallydropclassesin
accordancewiththerefundschedulepublishedontheStudentAccountswebpage
http://www.sunyorange.edu/studentaccounts
2. Someofyourfinancialaidawardsmaybereducedorcancelledif:(1)Youregisterforcoursesthatarenotapplicableto
yourdegreerequirementsor;(2)Changefromfulltimetoparttimestatus.
3. Iunderstandthatifmyimmunizationrequirementsarenotmet,Imaybedropped
frommyclasses.
4. IamawareoftheSUNYOrangecourseprerequisite/corequisitepolicyasoutlinedinourcatalogforeachcourse.
5. Iunderstandthatsomecoursesareofferedatmultiplelocations(Middletown,Newburgh,Online,etc.)andmyscheduleof
sectionshastakenthatinformationintoconsideration.
ProgramofStudy:
CRN
SUBJECT COURSE SECTION CAMPUS COURSETITLE CREDITS
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Total
Credits
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IacceptfinancialresponsibilityformySUNYOrangebillduringtheindicatedsemester.Iacknowledgethatmytuitionandfeesmustbepaidby
theduedateorIwillbeassesseda$50.00latepaymentfee.Irealizethatnonattendancewillnotrelievemyfinancialresponsibility.
IhavereadandunderstandtheSUNYOrangerefundpolicyandNYSresidencyrequirements.Iunderstandthatifacollegedebtisreferredto
outsidesourcesforcollection,Iwillberesponsibleforpayingadditionalcollectioncontingencyfees(upto50%ofthedelinquentaccount
balance).IunderstandthatIwillberestricted
fromregisteringforadditionalcoursesorforfuturetermsandmytranscriptsanddiplomaswill
beplacedonhold.
*PleasenoteyoumustcompletetheSICASAcceptChargesSurveybyloggingintoyourMySUNYOrangeaccount.
Student’s Name (Print Clearly) Student’s Signature Date:
Advisor’s Name (Print Clearly) Advisor’s Signature Date:
click to sign
signature
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click to sign
signature
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