Online Non-Matriculated Student Application

Semester you are applying for: Summer     Fall    Winterim    Spring        Year
Date:
First Name:
Middle Name:
Last Name:
Former Name:
Primary Address
Current Address (if different)
E-mail Address:
Home Phone:
Cell Phone:
Male    Female
Student ID number for previously enrolled or current Potsdam students:
Date of Birth:
(for data integrity purposes)


If you have previously filled out the Non-Matriculated student application, please jump to the Course Registration section of this page.
Are you a veteran or a dependent of a veteran? Yes    No
Are you a U.S. Citizen? Yes    No
Principal resident of New York State? Yes     No    If yes, # of years:

Are you Hispanic/Latino? Yes    No
If yes, select one:
Central American
South American
Dominican
Puerto Rican
Mexican
Cuban
Other Hispanic/Latino
Please indicate your race (select one or more):
White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian, Alaska Native or First Nations
Do any of these apply to you?
Taking prerequisites for an MST program
Taking prerequisites for Teacher Certification
College Advancement Program (CAP) for High School Students
Visiting student (currently matriculated or will be matriculated at another institution)
Professional Development Program (e.g. NYSSMA, Music Therapy) Please specify which Professional Development Program you are applying for below:
     
Have you ever attended SUNY Potsdam?
No    Yes     If yes, list most recent semester
If yes, did you graduate with a degree?
No    Yes
Briefly describe your reason for attending SUNY Potsdam:
Briefly describe your current educational status:
If you attended SUNY Potsdam previously under a different name, please indicate that here
List all secondary schools and colleges attended, beginning with the most recent and include date(s) of attendance:
School Name City, State, Zip Dates Attended Total Credits Cumulative GPA Degree Earned

International Students Only

Please complete the following:

Country of Birth:
Country of Citizenship:
State of Legal Residence:
If not a U.S. Citizen, have you applied for citizenship Yes    No
If yes, how many years have you been in the U.S.:
If not a U.S. Citizen, indicate your visa type:
F-1 Student
J-1 Exchange
Other     
Visa Expiration (Month / Year):

High School Students Only

Please complete the following:

Name of High School:
Location (City/State):
Expected Graduation:


Course Registration  

Please Note: Non-matriculated undergraduate students are restricted to no more than 8 credits per semester and 15 credits per year. Non-matriculated graduate students are restricted to 6 credits total unless approved for more under the lifelong learning agreement.
Course Code
Example: 10090
Course Number
Example: CHEM 101
Section Number
Example: 089
Course Title
If available
Credits
Example: 3
Please Note: Preference in courses is given to SUNY Potsdam matriculated students. To support this effort, non-matriculated students will not be enrolled in any courses until one week prior to the start of the semester, unless permission is granted by the professor. In the case of a course meeting max enrollment capacity, you may be bumped from said course if a matriculated student needs to take it.

Felony/Dismissal

REQUIRED FOR ALL APPLICANTS: even if you have never attended college, a response is required. A felony in New York 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 the felony question below by indicating a response of no. Suspension is defined as a sanction imposed for disciplinary reasons that result in a student leaving school for a fixed period of time, 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 admission, but you will be asked by SUNY Potsdam to provide additional information. A campus committee to ensure campus safety will review this information. Any falsification or omission of data may result in a denial of admission or dismissal.

Have you ever been convicted of a felony?
Yes    No
Have you been dismissed and/or suspended from a college for disciplinary reasons?
Even if you have never attended college, a response is required.
Yes    No

Acknowledgement

By checking the box below, you are affirming that the information you have provided on this application is truthful. Any falsification of answers to this application may result in disenrollment from the college.

I acknowledge that the answers I have provided on this application are truthful


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