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Creditregistrationform

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

BROWSE ORANGE COUNTY COMMUNITY COLLEGE FORMS

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Credit



Course



RegistrationForm



NewburghCampus

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



MiddletownCampus

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



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



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



EmailAddress:_____________________________________________



CountyofResidence ___________________ _____________________





_____________________________________________

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



OtherNamesUsed:___ ________________________________________ 



EmergencyContact:

Name:



Telephone#:



RelationshiptoYou:



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



AreyouHispanic/Latino?___Yes___No

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

___CentralAmerican___Dominican___Mexican

___PuertoRican___SouthAmerican___OtherHispanic/Latino



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

____White

____Black____Asian

____AmericanIndian/NativeAlaskan

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



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



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

____Yes____No

NameofHighSchool___ _________________

Continuetonextpage

___

Degree Seeking

____ Non Degree Seeking

Visiting Students:

SUNY College ______________________

Non SUNY College __________________



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



LastUpdate8/16/2018

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/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.



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Advisor’s Name (Print Clearly) Advisor’s Signature Date:

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Completed 9 March 2020

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