Page 1 of 2 Updated: 4/2/2020
Registration Form for Non-Matriculated Students
General Non-Matriculation Rules: Non-matriculated students may attend on a part-time basis only (11 credit max) and can earn a
maximum of 18 credit hours prior to matriculation. Non-Matriculated Students receive grades and GPA calculations but do not receive an
academic standing or academic honors. Non- matriculated students are not eligible to receive financial aid (i.e. Pell, TAP, Loans,
etc.). If you are looking to receive financial aid, you must apply and be accepted to the College. Please contact the Admissions office regarding applying to
the College as a matriculated student. I understand the General Non-Matriculation Rules noted above (initials): _____________
Registration Requirements:
1. Registration Form: Complete all requested information. Incomplete registration forms cannot be processed.
2. Proof of Identification: Individuals looking to register must provide proof of identification when submitting this form. Forms
of identification include; Government Issued ID, Marriage License, Social Security Card, or Court Order.
3. Proof of prerequisites: Students enrolling in courses with prerequisites (available in the College Catalog) are required to show proof
of prerequisites by submitting an unofficial transcripts or completing Placement Testing.
4. Proof of Immunizations: NYS Public Health Law and College policy can be found in the College catalog.
5. Submitting Forms: Completed forms and required documentation should be emailed, mailed, or faxed to the Office of Records and
Registration at the contact information noted above with required form of identification included or attached.
General Person Information
Semester: ❑ Summer ❑ Fall ❑ Winter ❑ Spring Year:
Student Type (Select One):
❑ Student with previous SUNY Adirondack credit or Continuing Education Registration.
❑ Student without SUNY Adirondack Credit or Continuing Education Registration.
Student Name (Please print):
First Middle Last
Former Name (Please print):
Identification listed above is required to make changes to the student’s legal name on all College records. Legal names must be provided.
Social Security Number or Banner ID (former students):
Date of Birth (mm/dd/yy):
Sex: ❑ Male ❑ Female
Permanent Address:
Street City State Zip
If you are a NYS resident, you must submit a Certificate of Residency to Student Accounts within 60 days of the beginning of the semester.
Phone (including area code): ❑ This is a Cell Phone ❑ This is not a Cell Phone
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 you are a non-citizen, we will require a copy of your visa.
*If no, are you a permanent resident? ❑ Yes ❑ No
If you are a permanent resident and listed a social security number, you must submit a copy of your social security card.
Visa Type: Nation of Birth/Citizen:
Foreign Students Only:
Please provide a permanent mailing address with postal code.
Race (check one or more): ❑ American Indian or Alaskan Native ❑ Asian ❑ Black or African American
❑ Native Hawaiian or Other Pacific Islander ❑ White
Are you Hispanic/Latino? ❑ Yes* ❑ No
*If yes, what is your ethnic background? ❑ Dominican ❑ Puerto Rican ❑ Mexican
❑ South American ❑ Central American ❑Other Hispanic/Latino
Emergency Contact Information Emergency Contact Name (Please Print):
Relationship to Student: Emergency Contact Phone #:
Office of Records and Registration
640 Bay Road, Queensbury, NY 12804-1445
CALL: 518.743.2279 | FAX: 518.832.7601 | EMAIL: registrar@sunyacc.edu
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