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

Address: 

City: 

County: 

State: 

Zip code: 

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