Visiting Student Registration Form
Important: Please type or print clearly.
Social Security Number (Optional) Date of Birth (Month/Day/Year)
I am applying as a visiting student for the
Queens campus Staten Island campus
8000 Utopia Parkway 300 Howard Avenue
Queens, NY 11439 Staten Island, NY 10301
I plan to start in
Fall 20 (September) Spring 20 (January) Summer 20
Applicant’s Last Name (Surname) First Name (Given Name) Middle Name
Address (Number and Street Address) Apartment No.
City State/Province Zip/Postal Code Country
Home Telephone (Include Area Code) Work Telephone (Include Area Code)
E-mail Address Gender Male Female
Have you previously attended St. John’s University? Yes
Ethnic Origin (Optional)
• In order to register, this form must be signed by a dean or registrar on side 2.
Completed form may be sent via fax to 718-990-1677, via e-mail (for scanned copy) to
visitingstudent@stjohns.edu, or via mail to:
St. John’s University
Office of the Registrar
Newman Hall, Room 106
8000 Utopia Parkway
Queens, NY 11439
Please read the instructions below carefully and complete the entire application.
Submit this form to the Office of the Registrar.
Please check one:
Select one or more categories to indicate what you consider yourself to be:
Hispanic or Latino Not Hispanic or Latino
American Indian or Alaskan Native
Native American or Alaskan Native
Asian or Far East
Indian Subcontinent
Asian, Other __________________
Black or African-American
Black, African-American
Black, African
Black, Caribbean/West Indian
Black, Other
Hispanic, Cuban
Hispanic, Mexican
Hispanic, Puerto Rican
Hispanic, South/Central American
Hispanic, Other ________________
Native Hawaiian
or Other Pacific Islander
Native Hawaiian
Pacific Islander
Arab, N. African, Middle East
Caucasian, All Other Heritage
Previous Dismissal or Suspension
Have you ever been disciplined for misconduct, suspended, expelled, or required to withdraw from any secondary or
postsecondary educational institution? If yes, please explain on a separate sheet of paper. Yes No
Have you been convicted of a felony? If yes, please explain on a separate piece of paper. Yes No
Your Signature
I, the undersigned, hereby apply for admission to St. John’s University. If accepted, I agree to abide by all the rules and regulations of the
University, including those set forth in the University bulletins. All information contained herein is, to the best of my knowledge, true
and complete. (Any omission or falsification of records is grounds for dismissal.)
Signature _________________________________________________________ Date (Month/Day/Year)
Courses to be Taken at St. John’s
Please indicate courses in order of preference. For a list of available courses, please visit stjohns.edu/courses.
Subject Course Number Course Reference Credit Hours Summer Session Only
Number [CRN] Pre Summer I Summer II Post Fall Spring
Educational Background
Name of College/University
City State From (Month/Year) To (Month/Year)
Graduation Date or
Expected Graduation Date
Certification for Students Enrolled in Other Institutions of Higher Education
This is to certify that _____________________________________ is in good standing at _________________________________ and
(Student Name) (Name of Institution)
has permission to register for the courses listed above.
_________________________________________________ _________________________________________________
(Signature of Dean/Registrar) (Title)
For more information, please visit our website at stjohns.edu/visitingstudents or call 1-888-9STJOHNS or 718-990-2000.
Religious Affiliation
Please check one:
Baptist Islamic Mormon/LDS Russian Orthodox Other _____________________
Buddhist Jehovah’s Witness Pentecostal Seventh Day Adventist
Episcopal Jewish Presbyterian Sikh
Greek Orthodox Lutheran Protestant Non-Denominational
Hindu Methodist Roman Catholic None