VISITING STUDENT REGISTRATION FORM
Last Name First Name MI
Street Address City State Zip
Home Phone Cell Phone Work Phone Email Address
County Sex (M,F) Ethnicity Race Birth date Citizen
(mm/dd/yy) (y, n)
Student Goals: Check the box next to the statement which most accurately reflects your current educational goal at SCCC:
□ 1. Transfer to another SUNY College after earning an SCCC degree/certificate □ 6. Learn new skills or upgrade existing skills without
□ 2. Transfer to a non-SUNY college after earning a degree/certificate at SCCC degree or certificate
□ 3.Transfer to another SUNY college without earning a degree/certificate at SCCC □ 7. Seek enrichment rather than pursue a degree or certificate
□ 4. Transfer to a non-SUNY college without earning a degree/certificate □ 8. Obsolete
□ 5. Earn a degree/certificate at SCCC and seek employment rather than □ 9.Uncertain
than pursue further post-secondary education
LIST HERE ALL OTHER COLLEGES ATTENDED:
CRN DEPT Course# SEC DAYS/TIMES CR NOTES or SPECIAL APPROVAL
I understand that I am responsible for knowing and meeting all program requirements.
I understand that Schenectady County Community College (SCCC) uses a collection agency as a means of debt collection. If it becomes necessary to
submit my account for collection, I agree to be responsible for collection costs of up to 40% in addition to the principal debt. I further understand that
any information I have provided to SCCC may be used to assist in debt collection.
Student Signature__________________________________________ Date______________ Processed______
Students wishing to cross register need to contact the Registrar’s office by emailing firstname.lastname@example.org. Any registration done
prior to cross registration approval will not be changed to a cross registration. You will be liable for all tuition and fees.
Please complete the necessary information below. If you are registering for a credit bearing course, per IRS Regulations your Social Security
number is required. Please do not include your Social Security Number on this form in any capacity. Once your registration has been
confirmed, you will receive a letter requesting you proivde your Social Security Number. This information may be returned to our office via
U.S. Mail or in-person.
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