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(Given)Name
Middle
Last(Family)
Former first and/or last names
Are you a U.S. Citizen or permanent resident?

Are you a U.S. Citizen or permanent resident? Yes No
SSN
Birthdate Birthdate / MM / DD YYYY
Visa Type

If registering for a WEB course only, please enter NR.
Country
Address Line 1
Address Line 2
City
State/Providence
ZIP/Postal Code
International Dial Codes

North America dial code is 1
Preferred Phone
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) Male Female
Gender Identity
(At this time, these optional choices are provided both by the State and Federal governments)

Gender Identity
(At this time, these optional choices are provided both by the State and Federal governments) Male Female Non-Binary Unknown
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?

Are you Hispanic/Latino? Yes No
Hispanic/Latino

Hispanic/Latino Central American Cuban Dominican Mexican South American Puerto Rican Other Hispanic/Latino
EDUCATION
Semester Attending.

Semester Attending. Fall Spring Winter Summer
Year
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.
Winter Session Note
Winter (session A) begins the last week of December of the this year, but is actually considered the first term of next year. Please select Winter and the year in which the session will finish (next year).
Campus(es) you will be attending?

Campus(es) you will be attending? Main Campus Branch Campus Plattsburgh Online
Is English your first language (the language spoken in your home)?

Is English your first language (the language spoken in your home)? Yes No
If Not, what is your first language?
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
List bachelor's degree-granting institution.
Is this your first attendance at SUNY Plattsburgh?

Is this your first attendance at SUNY Plattsburgh? Yes No
Last Date of attendance. Last Date of attendance. / MM / DD YYYY
College or University last attended.

If you have not attended any college or university, enter NA (not applicable)
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.
Are you a student in the Integrated Dual-Degree Nursing Program with Clinton Community College?

Are you a student in the Integrated Dual-Degree Nursing Program with Clinton Community College? Yes No
Are you participating in a COIL course?

Are you participating in a COIL course? Yes No
If Yes, List course subject/number and instructor.
IMPORTANT NOTES

 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.
 Registration Information: Registration application confirmation and registration dates/instructions will be forwarded to the email address provided above.
 Tuition and Fee Liability: By submitting this form I realize non-attendance does not remove tuition and fee liability. I also understand that I am subject to all academic policies and procedures.
 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 College reserves the right to deny course enrollment to any person as a non-matriculated student.

Non-Matriculated Student Application

Non-Matriculated Student Application

EDUCATION

IMPORTANT NOTES