Credit
Course
RegistrationForm
NewburghCampus
1WashingtonCenter,Newburgh,NY12550
MiddletownCampus
115SouthStreet,Middletown,NY10940
(845)341‐4140●registrar@sunyorange.edu
StudentInformation
Semester:FALL_____SPRING_____SUMMER_____
TermofLastRegistration:FALL_____SPRING_____SUMMER_____
A#________________________
LastNameFirstNameMiddleInitial
SSNorTaxIdentificationNumber*
______‐‐____‐‐________
StreetAddressCity StateZipCode
*SSNorTaxIdentificationNumberis
requiredbytheIRSforreportingof
tuitionandrelatedexpensesfortax
purposesandforfinancialaid.
Sex:__Male__Female
HomePhoneCellPhone
EmailAddress:_____________________________________________
CountyofResidence ___________________ _____________________
_____________________________________________
DateofBirthMM/DD/YYYY(Mandatory)
OtherNamesUsed:___ ________________________________________
EmergencyContact:
Name:
Telephone#:
RelationshiptoYou:
U.S.CITIZEN___YES_ __NO
IFNO(Checkone)
___PERMANENTRESIDENTALIEN
___NON‐RESIDENTALIEN(identifybelow)
WhatCountry?_____________________
VeteranStatus:
___VET
___DependentofVET
___ActiveDutyMilitary
AreyouHispanic/Latino?___Yes___No
IfHispanic/Latino,isyourbackground?(selectone)
___CentralAmerican___Dominican___Mexican
___PuertoRican___SouthAmerican___OtherHispanic/Latino
Allstudents,pleaseindicateyourrace.(selectoneormore)
____White
____Black____Asian
____AmericanIndian/NativeAlaskan
____NativeHawaiian/PacificIslanderEthnicity:
NameofotherCOLLEGE(s)attended(upto2)
AreyouaHighSchoolGradorGEDRecipient?
____Yes____No
NameofHighSchool___ _________________
Continuetonextpage
___
Degree Seeking
____ Non Degree Seeking
Visiting Students:
SUNY College ______________________
Non SUNY College __________________