Summer Visiting Student Credit Registration Form

1Contact Information

2Personal Information

3Residential Information

4Academic Information

5Course 1

6Course 2

7Course 3

8Course 4

9Course 5

10Electronic Signature

11Review Your Entry

Student Name Student Name * First Middle Last
Student Home Phone Student Home Phone - ### - ### ####
Student Cell Phone Student Cell Phone - ### - ### ####
Contact Name: Contact Name: * First Last
Contact Telephone #: Contact Telephone #: * - ### - ### ####
Relationship to You: *
Have you previously attended SUNY Orange? *

Have you previously attended SUNY Orange? Yes No
Please indicate which semester you would like to attend as a visiting student: *

Please indicate which semester you would like to attend as a visiting student: Fall Semester Summer Semester
Did you hear about SUNY Orange in your high school? *

Did you hear about SUNY Orange in your high school? Yes No Not sure
Where have you seen or heard SUNY Orange advertised? *

Where have you seen or heard SUNY Orange advertised? Radio or Streaming Music Ad (please enter which below) Newspaper Ad or Story (please enter which below) TV Ad - Cable/Satellite/Streaming (please enter which below) Social Media Ad (please enter which below) Video ad playing before online video Banner on mobile app Banner on a website Google search for local colleges, degrees, or education Word of Mouth (Family / Friend) Other Other
Which Radio Station(s) or Streaming Service(s):
Which Newspaper(s):
Which Cable/Satellite/Streaming Service(s) and Channel(s)?
Which Social Media Platform(s)?
Which Radio/Streaming platforms?

Which Radio/Streaming platforms? WRRV-FM WEOK-AM (Juan Radio) K104.7 FM (WSPK) SPOTIFY PANDORA I HEART RADIO STREAM PODCAST Other Other
Which newspapers?

Which newspapers? Times Herald Record Beacon Free Press Cornwall Local Goshen Chronicle Goshen Independent Hudson Valley Press Mid-Hudson Times Monroe Photo News News of the Highlands Pike County Dispatch Pike County Courier Port Jervis Gazette Southern Ulster Times Wallkill Valley Times Warwick Advertiser Warwick Valley Dispatch Other Other
Which TV services?

Which TV services? Cable TV HULU Other Other
Which Social Media?

Which Social Media? Facebook Instagram Snapchat Twitter Other Other
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Enter Your Email Address *

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