Office of Records and Registration
640 Bay Road, Queensbury, NY 12804-1445
CALL: 518.743.2279 | FAX: 518.832.7601 | EMAIL: registrar@sunyacc.edu
Non-Matriculated Student Registration Form
NON-MATRICULATED STUDENT POLICY: Non-matriculated students are not eligible to receive financial aid (i.e. Pell, TAP, Loans,
etc.). Non-Matriculated Students receive grades and GPA calculations but do not receive an academic standing or academic honors.
Non-matriculated students can earn a maximum of 36 credit hours at SUNY Adirondack prior to matriculation. Students nearing the
36 credit hour limit should contact the Admissions Office to learn more about matriculation. Information about matriculation are available
in the College Catalog at; http://catalog.sunyacc.edu/admissions/quickguide.
I understand the non-matriculated student policy outlined above and available in the Catalog: ______________ (Initial)
NON-MATRICULATION STEPS:
• Submit this completed form to the Office of the Registrar (via email, fax, or mail) including;
o A form of identification (i.e. Government Issued ID, Marriage License, Social Security Card, or Court Order).
o IRS regulations require the College to collect Social Security numbers for students registered in credit-baring coursework. A
staff member can schedule a phone call or Zoom session for you to provide this information for our records if you prefer instead
of submitting via this form.
o Transcript information as evidence of course prerequisite with this form (if applicable).
• Submit proof of immunizations as required by relevant NYS Public Health Laws to the Office of the Registrar (students taking less
than six in-person credit hours are exempt from this requirement but are strongly encouraged to submit) by the first day of class.
• Submit a Certificate of Residence to the Student Accounts Office within 60 days of the beginning of the semester.
GENERAL PERSON INFORMATION:
Semester: ❑Summer ❑Fall ❑Winter ❑Spring Year: 20___________
Student Type:
❑New (first time/transfer) student at SUNY Adirondack for the semester of registration
❑ I have previously registered for or earned credit at SUNY Adirondack.
If you are a returning matriculated student at SUNY Adirondack, please contact advising@sunyacc.edu.
Student Name: _______________________________________________________________________________________________
Former Name: _______________________________________________________________________________________________
Social Security Number or Banner ID (former students): _______________________________________________________________
A staff member from the Registrar’s Office can schedule a phone call or Zoom session for you to provide this information for our records if
you prefer instead of submitting via this form. If you would like us to do this, please note this and make sure your contact information is
correct for us to schedule a time or call and speak to you.
Date of Birth (MM/DD/YY): _________________________________ Sex: ❑ Male ❑ Female
Permanent Address: ___________________________________________________________________________________________
Phone (Including Area Code): ___________________________________________________________________________________
Email Address: _______________________________________________________________________________________________
We will be sending follow up communications to this address. Please provide a personal email you check regularly.
CITIZEN, RACE, AND ETHNICITY INFORMATION:
Are you a US citizen? ❑ Yes ❑ No *If no, are you a permanent resident? ❑ Yes ❑ No
If you are a non-citizen, we will require a copy of your visa. Visa Type: ______________ Nation of Birth/Citizen: ____________________
Foreign Students must provide their permanent non-United States address: ________________________________________________
___________________________________________________________________________________________________________
Race (check one or more): ❑American Indian or Alaskan Native ❑ Asian ❑Black or African American
❑ Native Hawaiian or Pacific Islander ❑ White
Are you Hispanic/Latino? ❑No/Prefer not to answer
❑Central American ❑Dominican ❑Mexican ❑Puerto Rican ❑South American ❑Other Hispanic/Latino
EMERGENCY CONTACT INFORMATION:
Emergency Contact Name: _____________________________________________________________________________________
Relationship to Student: ______________________________ Emergency Contact Phone Number: _____________________________
Updated 12/10/2020
