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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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Education Information
Name of High School:
GED/TASC Date Completed:
Year Graduated:
Other Colleges Attended or Currently Attending:
Have you ever been dismissed and/or suspended from a college for disciplinary (non-academic) reasons? Yes No
Requested Courses (11 credits maximum per semester, with a maximum of 18 credit hours earned prior to matriculation.)
CRN (Required)
Subject and Course Number
Credits
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. As noted previously, Non-Matriculated students are not eligible for federal or state
Financial Aid. 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 registrar@sunyacc.edu for processing
For Registrar Use Only: Banner ID Number:
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
Follow-up communication Sent via Mail or Email including; Technology Guide Schedule Bill Immunization Forms (6 + Credits)
Additional Notes or Communications with Student: Initials: __________ Date: _________
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