Credit
Course
RegistrationForm
NewburghCampus
1WashingtonCenter,Newburgh,NY12550
MiddletownCampus
115SouthStreet,Middletown,NY10940
(845)3414140●registrar@sunyorange.edu
StudentInformation
Semester:FALL_____SPRING_____SUMMER_____
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TermofLastRegistration:FALL_____SPRING_____SUMMER_____
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A#________________________
LastNameFirstNameMiddleInitial 
SSNorTaxIdentificationNumber*
______‐‐____‐‐________
StreetAddressCity StateZipCode
*SSNorTaxIdentificationNumberis
requiredbytheIRSforreportingof
tuitionandrelatedexpensesfortax
purposesandforfinancialaid.
Sex:__Male__Female
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HomePhoneCellPhone
EmailAddress:_____________________________________________
CountyofResidence ___________________ _____________________
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DateofBirthMM/DD/YYYY(Mandatory)
OtherNamesUsed:___ ________________________________________ 
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EmergencyContact:
Name:
Telephone#:
RelationshiptoYou:
U.S.CITIZEN___YES_ __NO
IFNO(Checkone)
___PERMANENTRESIDENTALIEN
___NONRESIDENTALIEN(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 __________________
FOROFFICEUSEONLYDATE:_______INITIALS:_____
LastUpdate8/16/2018
CourseRegistrationDetails
1. Youareobligatedtopayinfullalltuitionandfeeswhetherornotyouattendclassesunlessyouofficiallydropclassesin
accordancewiththerefundschedulepublishedontheStudentAccountswebpagehttp://www.sunyorange.edu/bursar/
2. Someofyourfinancialaidawardsmaybereducedorcancelledif:(1)
Youregisterforcoursesthatarenotapplicableto
yourdegreerequirementsor;(2)Changefromfulltimetoparttimestatus.
3. Iunderstandthatifmyimmunizationrequirementsarenotmet,Imaybedroppedfrommyclasses.
4. IamawareoftheSUNYOrangecourseprerequisite/co
requisitepolicyasoutlinedinourcatalogforeachcourse.
5. Iunderstandthatsomecoursesareofferedatmultiplelocations(Middletown,Newburgh,Online,etc.)andmyscheduleof
sectionshastakenthatinformationintoconsideration.
ProgramofStudy:
CRN
SUBJECT COURSE SECTION CAMPUS COURSETITLE CREDITS
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Total
Credits
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IacceptfinancialresponsibilityformySUNYOrangebillduringtheindicatedsemester.Iacknowledgethatmytuitionandfeesmustbepaidby
theduedateorIwillbeassesseda$50.00latepaymentfee.Irealizethatnonattendancewillnotrelievemyfinancialresponsibility.
Ihave
readandunderstandtheSUNYOrangerefundpolicyandNYSresidencyrequirements.Iunderstandthatifacollegedebtisreferredto
outsidesourcesforcollection,Iwillberesponsibleforpayingadditionalcollectioncontingencyfees(upto50%ofthedelinquentaccount
balance).IunderstandthatIwillberestrictedfromregisteringforadditionalcoursesorforfuturetermsandmytranscriptsanddiplomaswill
beplacedonhold.
*PleasenoteyoumustcompletetheSICASAcceptChargesSurveybyloggingintoyourMySUNYOrangeaccount.
Student’s Name (Print Clearly) Student’s Signature Date:
Advisor’s Name (Print Clearly) Advisor’s Signature Date: