Non-Matriculated Student Application

Non-Matriculated Student Application

Completion of this form does NOT register the student into courses. After the Registrar processes this form, you will then be sent further information via a second email.

First Name (Given)
Chosen Name (Not required)

You may enter a preferred first name, if it is different from your legal first name.
Middle
Last (Family)
Do you have any previous or other LEGAL names?

Do you have any previous or other LEGAL names? Yes No
Please list your previous/other LEGAL names here.
Birthdate Birthdate / MM / DD YYYY
Are you a U.S. Citizen or permanent resident?

Are you a U.S. Citizen or permanent resident? Yes No
Visa Type

If registering for a WEB course only, please enter NR.
SSN
Must be 9 digits. Currently Entered: 0 digits.
Address Line 1
Address Line 2
City
State/Providence
ZIP/Postal Code
Country
International Dial Codes

North America dial code is 1
Preferred Phone
Must be 10 characters. Currently Entered: 0 characters.
Alternate Phone
Email
Gender
(At this time, these options as they are presented are required by the State and Federal governments)

Gender
(At this time, these options as they are presented are required by the State and Federal governments) F M X
Gender Identity
(At this time, theses optional choices are provided by both the State and Federal governments.)
Are you a New York State Resident?

Are you a New York State Resident? Yes No
Have you been a permanent NY resident for the last 12 months?

Have you been a permanent NY resident for the last 12 months? Yes No
Race (check one or more)

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/a/x?

Are you Hispanic/Latino/a/x? Yes No
Hispanic/Latino

Hispanic/Latino Central American Cuban Dominican Mexican South American Puerto Rican Other Hispanic/Latino
Is English your first language (the language spoken in your home)?

Is English your first language (the language spoken in your home)? Yes No
What is your first language?
EDUCATION
Semester Attending
Campus(es) you will be attending?

Campus(es) you will be attending? Main Campus Plattsburgh Online Branch Campus (Queensbury)
Is this your first attendance at SUNY Plattsburgh?

Is this your first attendance at SUNY Plattsburgh? Yes No
Are you currently a High School Student?
High School Name
Are you a High School Model OAS student

Are you a High School Model OAS student Yes No
Highest Academic Level Completed
College or University last attended.

If you have not attended any college or university, enter NA (not applicable)
List most recent degree-granting institution.
Have you been dismissed, expelled, and/or suspended from a college for disciplinary reasons? (Not including Academic Dismissals)

Have you been dismissed, expelled, and/or suspended from a college for disciplinary reasons? (Not including Academic Dismissals) Yes No

Disciplinary Action: Suspension is defined as a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed period, less than permanently. Dismissal from a college for disciplinary reasons is defined as a permanent separation from an institution of higher education on the basis of conduct or behavior and not on academic performance.

An affirmative response will not automatically prevent registration, but you will be asked to provide additional information. Any falsification or omission of data may result in denial of registration or dismissal.
Have you been convicted of a felony?

Have you been convicted of a felony? Yes No

Felony/Disciplinary Note: A felony in NY State law is defined as a crime for which more than one year in prison may be imposed. The felony question applies if you have been
convicted as an adult. If you have been adjudicated as having juvenile delinquent or youthful offender status, you are required to respond to the felony question by indicating a
response of “no.”
Suspension is defined as a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed time period, less than permanently. Dismissal from a college
for disciplinary reasons is defined as permanent separation from an institution of higher education on the basis of conduct or behavior.
An affirmative response to either question will not automatically prevent enrollment, but you will be asked to provide additional information. This information will be reviewed by a
campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of enrollment or dismissal.
IMPORTANT NOTES & CONDITIONS

IMPORTANT NOTES & CONDITIONS Graduate Students: A maximum of 12 graduate credits completed as a non-matriculated student may apply toward a graduate degree program. If you are nearing the 12-credit limit, contact our Graduate Admissions Office (518-564-GRAD) to learn more about matriculation. An email confirming receipt of your submission will be sent to the email address that you have provided. A second email with registration dates/instructions will be sent to the same address after your request has been processed by the Registrar's office. After students have registered for coursework, all emailed communications must occur via the Plattsburgh.edu server. For security and identity-confirmation purposes, please do not send messages from your personal email. Social Security Number: Personal student information is treated confidentially and consistent with the Family Educational Rights and Privacy Act (FERPA), the NYS Cyber Security Policy P03-002: Information Security Policy, and is compliant with NYS General Business Law Section 399-ddd. The University reserves the right to deny course enrollment to any person as a non-matriculated student.

Please check each box in acknowledgement.
The information I have provided is accurate and I understand the notes and conditions outlined above.

This will serve as your electronic signature.