Fillable Credit Registration Form 002 (Orange County Community College)

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Credit Registration Form 002 (Orange County Community College)

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The Credit Registration Form 002 (Orange County Community College) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Orange County Community College

BROWSE ORANGE COUNTY COMMUNITY COLLEGE FORMS

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Student Information
Semester: FALL_____ SPRING _____ SUMMER_____
Term of Last Registration: FALL_____ SPRING _____ SUMMER
_____
A# ___ ___ ___ ___ ___ ___ ___ ___
Last Name First Name Middle Initial
SSN or Tax Identification Number*
__ __ __-- __ __ -- __ __ __ __
Street Address City State Zip Code
*SSN or Tax Identification Number is
required by the IRS for reporting of
tuition and related expenses for tax
purposes and for financial aid.
Sex: __ Male __ Female
Home Phone Cell Phone
County of Residence _______________________________
_____________________________________________
Date of Birth MM/DD/YYYY (Mandatory)
Other Names Used:___________________________________________
Emergency Contact:
Name:
Telephone #:
Relationship to You:
Citizenship:
U.S. CITIZEN ___YES ___NO
IF NO (Check one)
___ PERMANENT RESIDENT ALIEN
___ NON-RESIDENT ALIEN (identify below)
What Country? _____________________
Veteran Status:
___ VET
___ Dependent of VET
___ Active Duty Military
Select One or More:
____ 01 White ____ 02 Black ____ 04 Asian
____ 05 American Indian/Native Alaskan
____ 08 Native Hawaiian/Pacific Islander
(Note: DUE TO NEW GOVERNMENTAL REPORTING
REQUIREMENTS, PERSONS WHO ARE HISPANIC/LATINO
MUST RESPOND TO THE ABOVE AND THEN COMPLETE THE
FOLLOWING SECTION BELOW)
Are you a High School Grad or GED Recipient?
____ Yes ____ No
Name of High School _____________________
Name of other COLLEGE(s) attended (up to 2)
Ethnicity: Are you Hispanic/Latino? ___Yes ___No
www.sunyorange.edu
CREDIT COURSE REGISTRATION FORM
Middletown Campus
115 South Street
Middletown, NY 10940
(845) 344-6222
Newburgh Campus
1 Washington Center
Newburgh, NY 12550
(845) 562-2454
___ Degree Seeking
____ Non Degree Seeking
Visiting Students:
SUNY College ______________________
Non SUNY College __________________
OVER
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/bursar/
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:
CRN
SUBJECT
COURSE
SECTION
CAMPUS
COURSE TITLE
CREDITS
Total
Credits
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.
*Please note you must complete the SICAS Accept Charges Survey by logging into your MySUNYOrange account.
Student’s Name (Print Clearly) Student’s Signature Date:
Advisor’s Name (Print Clearly) Advisor’s Signature Date:
COURSE REGISTRATION GRID
FOR OFFICE USE
Fall___Spring___Summer___
Date:___________________
Registered by:____________
Revised February 9 , 2018
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Credit Registration Form 002 (Orange County Community College)

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Completed 19 July 2020

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