Statement of Financial Responsibility and Registration Verification
By registering for classes at SUNY Adirondack, I acknowledge and agree that I am financially responsible for all charges related to my
registration and housing.
I understand that if financial payment and/or arrangements have not been made by the due date, the College reserves the right to remove
me as a student for non-payment, deny me access to my registered classes, and/or place a "hold" on my student records restricting me
from registering, graduating, and/or obtaining a transcript until the account is paid in full. I am responsible for all late charges incurred.
Failure to attend classes does not absolve me from financial liability. In all cases it is my responsibility to drop classes by the published
drop/add date(s) and I accept financial liability for these classes in accordance with the SUNY Adirondack Bill Adjustment/Liability
Schedule. SUNY Adirondack may call (personally or automated) or text any phone number that I have provided to the College and leave
a message regarding any outstanding account I have. I understand that, if the College texts me, I will be able to opt out. The College
may use a collection agency or take legal action for any account balance due and I will be responsible for all charges owed which may
include collection and/or litigation costs or attorney fees.
I understand that the College will (1) electronically post my 1098-T form (Tuition Statement) to my Banner account so I can download the
form for tax purposes and (2) mail a paper copy of my 1098-T to my primary address on file. I understand that I am responsible for
providing the College with updated contact information either through Banner or in person at the Registrar's Office in Warren Hall or at
SUNY Adirondack Saratoga.
Federal and State Financial Aid Acknowledgement and Permission Statement: I understand that financial aid (state and federal) is
only available to matriculated students. A matriculated student is a student who has been accepted to the College and is pursuing a
SUNY Adirondack degree. If I am a matriculated student who is eligible for financial aid and my financial aid is reduced or canceled for
any reason, I am responsible for all charges on my account. I give SUNY Adirondack permission to use any federal student aid (Pell
Grant, SEOG, Direct Loan) to pay any current charges that I incur for educational related activities and any other charges (institutional
and non-institutional) related to my attendance. I understand that at any time I may contact the Student Accounts (Bursar) Office to revoke
this permission regarding the use of my federal student aid.
My signature below indicates that I am in agreement with and/or acknowledge the statements above. I certify that the information provided
on this registration form is correct and that I have read all instructions and statements on this form and understand the implications and
requirements for registration at SUNY Adirondack. Acceptance and acknowledgement of this Financial Responsibility Agreement is
required in order to process your course registration.
Student Signature: Date:
__________________
Completed forms, prerequisite proof if necessary and a copy of your ID should be emailed to advising@sunyacc.edu for approval by an
academic advisor. Forms will then be sent to the registrar@sunyacc.edu for processing.
Declaration of Major for first semester students: Continuing or Returning students should use the Change of Major form.
Declaration of Primary Major:
Declaration of Secondary Major:
Student Success Center/Wilton Staff/Faculty Advisor Use Only:
If prerequisite is not in Banner but is required for registration, what was submitted or reviewed:
☐
High School Transcript* ☐ College Transcript* ☐ AP, CLEP, or IB Test Scores* ☐ Placement Test Scores
*Unofficial transcripts are acceptable for registration but official transcripts and scores will be needed for transfer credit to be awarded.
Additional Notes:
Advisor Signature:
Advisor Printed Name:
Date:
For Registrar Use Only: Initials: Date Processed:
_________________
Follow-up communication Sent via ❑ Mail or ❑ Email including; ❑ Technology Guide ❑Schedule ❑Bill ❑ Immunization Forms
Additional Notes or Communications with Student:
click to sign
signature
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