Fillable Non Matric Registration Form

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Non Matric Registration Form

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The Non Matric Registration Form form is 1 page long and contains:

  • 1 signature
  • 5 check-boxes
  • 95 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Clinton Community College

BROWSE CLINTON COMMUNITY COLLEGE FORMS

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Registration Form
Matriculated Students
Revised
10/12
for
Non
-
__________________________________
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_ _/_ _/_ _
______________________________________
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________
_____________________________
______
___________
_
_
________________________________________________
_________
____________________
______
___________
__
Course Information
Days the Course Meets
Course Time
1
. Name
Last
First
Middle Initial
2
. Social Security Number
_
3.
Date of Birth
4
.
Home
Address
Number
Street
City
S
tate
Z
ip
Code
5
.
Local Address
Number
Street
City
State
Zip Code
6
.
Primary
Phone
#:
_________________
_
_
__
7
.
Emergency
Phone
#:
______________
_
__
8. E
-
Mail:
_______________________________
_________________________________
Initials
Number
Section
Sem.
Hours
Mon
Tue
Wed
Thur
Fri
Sat
Begin
End
ENG
101
01C
3
X
X
X
8:00
8:50
I am registering as a Non
-
Matriculated student, and affirm that I am not in pursuit of a degree or certificate at Clinton Community College at the time
of this
registration. I understand that as a Non
-
Matriculated student, I am not entitled to receive financial aid for the courses for which I register. I further understand t
hat
should I decide to matriculate for a later semester, I will be required to go
through the college’s admission process and that the grades and
G
PA (
Grade
Point Average) I
earn as a Non
-
Matriculated student will factor into the determination of my eligibility for financial aid at the time of my matriculation.
Your Signature
_______
____________________________________
Date __ __ / __ __ / __ __
9. Gender
?
F
?
M
10. State of Residency ____________
11. If a NYS Resident, Official
County of Residence:
______________________________
1
2
.
Country of Citizenship:
____________________________
___
1
3
.
Permanent Country of Residence:
________
____________________
___
14
.
Visa Code:
____
____
Hispanic Code
_
__
_
____
Race
White
?
Black/African American
?
Asian
?
Hawaiian/Pacific Islander
?
American Indian/Alaskan
?
Unknown
?
Fall 20 __ __ Spring 20 __ __
Summer 20 __ __ Winter 20 __ __
___ ___
18. Name of
High School and State Located: __________________________________________
20.
Ex:
(if applicable)
15. Military Service Code:
(see next page)
16. Ethnicity:
(select one, codes
listed on next page)
(check all that apply)
17. If you are a Clinton County resident, please give your Legislative
District Code: (see next page)
19
. High
School Graduation Code:
(see next page)
_______
Year of High School Graduation or last year you attended: ____________________________
SUBMIT
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signature
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15
.
Military Status:
Code
16
.
Hispanic Codes:
Code
17
.
Legislative Districts:
Code Area Covere
d
19
.
High School Graduation Codes:
Code
1 Active Military Dut
y
2 Dependent of Active Duty Military Personne
l
3 Veteran
4 National Guard or Active Reserv
e
5 Other (Incl uding Never Served)
01 Non-Hispanic
02 Dominican
03 Mexican
04 Pue
r
to Rican
05 C entral American
06 South American
0
7
Other Hispanic/Latino
08 Unknown
09 Hispanic – Used When Hispanic Origin Cannot Be
Determined
01 Champlain, Mooers, Rouses Poin
t
02 Al tona, Churubusco, Dannemora, Elle nburg, Lyo
n
Mountain, Mooers Forks
03 Beekmantown, Chazy, West Chazy
04 North of Plattsburgh (Tom Miller/Wallace Hill
Road areas), Cumberland Head, Point Au Roche
05 Morrisonville, Schuyler Falls
06 Black Brook, Cadyville, Dannemora, Redford,
Saranac, Standish, West Plattsburgh
0
7
Ausable, C lintonville, Harkness, K eeseville, Peru,
Valcou r
08 Cliff H
a
ven, Plattsburgh Air Ba se, Sout
h
Plattsburgh, and the following City of Plattsburgh
Polling Places: Lakeview Towers, John C ollins
Communit y Center, Government Center Meeting
Room
09 City of Plattsburgh Polling Places: OLVA School,
Broad Street School, Plattsburgh High School,
Hudson Hall (Science Building)
10 City of Plattsbur gh Polling Places: Beekman Stree
t
Methodist Church, Bailey Avenue School, Oak
Street School, City Hall Rotunda
Y Gra
duated or Will Graduate Before Enrolling
H Home School Graduate
G General Education Diploma
A Still Aending High School
N Never Graduated
U Unknown High School Status
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Non Matric Registration Form

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Completed 10 February 2020

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