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, 2023. 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.
Relationship:
First Name:
Last Name:
Phone Type:
Phone Number:
Certificate of Residency
I understand that the Certificate of Residency must be either emailed to certs@sunysullivan.edu, faxed to 845-434-0014, mailed or hand-delivered to SUNY Sullivan's One Stop Center as soon as possible:
SUNY SullivanATTN: Student Billing112 College RoadLoch Sheldrake, NY 12759
Signature:
(Type out your full name)
Student Acknowledgement
I have read, understood, and agree with the requirements and procedures of the SUNY Sullivan College in the High School program. I also understand that registration in the program will create a permanent academic history and transcript at SUNY Sullivan. I agree that SUNY Sullivan may release my transcript to my high school without my permission until I have graduated from high school. I also understand and agree that SUNY Sullivan reserves the right to notify my parents and high school if I become involved in any incident requiring disciplinary action.
Parent/Guardian Acknowledgement
As the parent or guardian of the SUNY Sullivan College in the High School program student, I too have read, understood and agreed with the requirements, limitations and procedures of SUNY Sullivan’s College in the High School program. I also understand and agree with the creation of a permanent academic history and transcript at SUNY Sullivan for my child, the release of my child’s transcript to the high school until my child’s graduation, and the right of the college to notify my if my child becomes involved in any incident requiring disciplinary action. I also understand that some courses may deal with adult content subject matter. Furthermore, I accept full responsibility for all tuition and fees that result from my child’s registration in courses through the SUNY Sullivan College in the High School program.