College Student Registration Form
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1
2Student REGISTRATION FORM |
Part 1 of 2
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FALL
WINTER
SPRING
SUMMER YEAR: 20_____ Check ONE semester only.
CONTACT INFORMATION:
Complete the information below. Please print clearly.
Name_________________________________________________________________
Student ID Number_____________________________________________________
Former Name (if applicable)_____________________________________________
Social Security Number ________________________________________________
Permanent Address _______________________________________ Apt #_______
Phone (home) ________________________________________________________
City/State/Zip__________________________________________________________
Phone (cell) ___________________________________________________________
County of Residence___________________________________________________
E-mail ________________________________________________________________
Local Address
Emergency Contact Person_____________________________________________
(if different than above) ______________________________________________________
City/State/Zip__________________________________________________________
Emergency Contact Phone______________________________________________
NEW YORK STATE REQUIRED INFORMATION:
Please complete the information below. Print clearly.
Birth Date
: _____/_____ /_____
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(Month/Day/Year)
Graduated from High School?
Yes
No
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Gender:
Male
Female
Date of H.S. Graduation or Anticipated Graduation __________________
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Military Service Status (please check one if applicable):
Received G.E.D.?
Yes
No Date received G.E.D. ____________
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Active Military Duty
Check all that apply:
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Dependent of Active Duty Personnel
I am a single parent
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Veteran
I am a displaced homemaker
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Dependent of Veteran
Check only ONE statement that corresponds to your goal for
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National Guard or Active Reserve
attending TC3:
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Other
1. Transfer to another SUNY college after earning a degree.
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2. Transfer to a non-SUNY college after earning a degree.
Citizenship Information:
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3. Transfer to another SUNY college without earning a degree.
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U.S. Citizen
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4. Transfer to a non-SUNY college without earning a degree.
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Permanent Resident – Country of citizenship___________________
5. Earn a degree/certificate and seek employment rather than pursue
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Not a U.S. Citizen – Country of citizenship _____________________
further post secondary education.
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6. Learn new skills or upgrade existing skills without earning a degree.
Visa Type ______
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7. Seek enrichment rather than to pursue a degree/certificate.
English is not my first language
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8. Obtain a Certificate of General Education Development (GED)
My first language is__________________________________________
through the accumulation of college credits.
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9. Uncertain. Student has not determined his/her educational goal
Please indicate your ethnicity (select one or more):
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at this time.
American Indian or Alaskan Native
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Asian
Check only ONE of the statements below:
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Black – African American
I am a current student at TC3.
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Native Hawaiian or Other Pacific Islander
I have attended TC3 in the past.
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White
I have never attended TC3.
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I have never attended TC3, but have attended another college.
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Are you Hispanic/Latino?
Yes
No
The college I last attended was:
If yes, check only ONE of the following:
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Central American
South American
_________________________________________________________________
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Dominican
Cuban
If you received a degree, please specify the degree:
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Mexican
Other Hispanic/Latino
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AAS
AA/AS
BA/BS
Masters
Ph.D.
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Puerto Rican
revised 1/15
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