Microcredential Application

Microcredential Application

First Name (Given):
Middle Name:
Last (Family):
Birthdate Birthdate / MM / DD YYYY
Do you have any former/alternate LEGAL name(s)?

Do you have any former/alternate LEGAL name(s)? Yes No
Please list any LEGAL names that you have used in the past.
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.
Contact Information & Demographics
Mailing Address Line 1:
Address Line 2:
City:
State/Providence:
ZIP/Postal Code:
Country:
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 goverments)
Gender Identity (optional)
(At this time, these optional choices are provided by both the State and Federal governments)
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 Choose not to answer
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
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.
Education
Have you ever attended SUNY Plattsburgh before?

Have you ever attended SUNY Plattsburgh before? Yes No
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) No Yes

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.
Highest academic level completed:
List degree-granting institution.
Enrollment Details
Please select your intended Microcredential program:

Please select your intended Microcredential program: Introduction to Cannabis Therapeutics Introduction to Cannabis Science Beginning French Intermediate French
Semester of Enrollment

Semester of Enrollment Fall 2025 Winter 2026 Spring 2026
IMPORTANT NOTES, TERMS, & CONDITIONS

IMPORTANT NOTES, TERMS, & CONDITIONS Registration Information: Registration application confirmation and registration dates/instructions will be forwarded to the email address provided above. After a student is registered for coursework, it is the expectation that all communication is to be received and sent via their Plattsburgh.edu email account. I understand that I am financially and academically liable for classes that appear on my course schedule. Once I have been registered for a course, I will be charged tuition and receive a grade unless I drop or withdraw before the deadline. I will NOT be automatically withdrawn from a course in which I am registered if I do not attend it. I understand that I am subject to all academic policies and procedures. Social Security Number: Providing your Social Security Number to SUNY Plattsburgh is optional (some state and federal certifications/licensure may require a SSN to be associated with your record). 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 read each item and check the corresponding box to indicate understanding.
By typing your initials below, you are attesting to the accuracy of the information above.