High School:
Year:
Term
Have you ever taken a class at SUNY Sullivan before?
Enter your SUNY Sullivan student ID Number:
By checking this box, I understand that in addition to this application, I must submit a course registration form along with payment by September 16, 2022. The registration form is available from your Guidance Counselor. Not applicable to Fallsburg and Homestead School students.
I understand:
Legal Name:
First:
Middle:
Last:
Preferred First Name:
Mailing address and legal home address are the same
Mailing Address:
Address:
City:
County:
State:
Zip code:
Home Address
Home Phone
Cell Phone
Email Address:
Sex:
Gender Identity:
Date of Birth
Citizen of the United States of America
Social Security Number:Note: Needed for financial aid and IRS 1098T form.
Ethnicity:Note: Select "Hispanic or Latino" if you are a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Race:Note: Mark one or more races to indicate what the candidate considers himself/herself to be.
please verify the form is complete and accurate before hitting submit