Admissions Application

First Name*

Middle Name

Last Name*

Preferred Name

Previous Names Used

Date of Birth*Please enter as MM/DD/YYYY

SSNEnter your United States Social Security Number (if one has been assigned). Providing a Social Security Number is voluntary, however, it will assist us in matching test scores and transcripts with your admission application and facilitate the administrative process if you are admitted. Financial support is required to provide a valid United States Social Security Number prior to receiving stipends. This information will be used only as a highly confidential, personal identifier for statutory reporting purposes. If you do not have a valid Social Security Number or do not wish to report it, please leave this field blank. Entering an invalid number will delay your application processing.

Semester*

Major Choice / Academic Program*

Campus*

Enrollment Status*

Mailing Address*

City*

State*

Zip*

Phone Number*

Would you like to receive texts at the phone number provided?

Yes

No

E-mail Address*

What is your preferred method of communication?

E-mail

Texting

Phone Call

Citizenship*

If "Other" please enter Country name.

NYS Residence County*Non NYS Residents, please choose Out of State or Out of Country

High School NameHigh School Name or GED

Date of High School Graduation or GED CompletionPlease enter as MM/DD/YYYY

Have you ever attended another college?*

Yes

No

Have you ever been dismissed from a college for disciplinary reasons?*

Yes

No

Please list any Previous Colleges?Please list any previous Colleges you have attended

Gender*

Ethnicity

US Military Service

Verification

I attest that I am the person whose name appears on this admissions application. I declare that the information provided on this admission application is complete and accurate and I willingly submit this application to North Country Community College of the State University of New York, a governmental entity. I acknowledge that I have read and understood all terms and conditions of admission to North Country Community College as presented on this application, the College website, publications, and in the College catalog. I understand that if I am not granted admission into the program of choice I have selected, an alternative program may be selected for me by the College. in accordance with the Family Educational Rights and Privacy Act, authorize North Country Community College access to any and all of my previous academic records and other such records as may be required to complete my admission application.

Signature*Please type your name here