Application: SUNY Orange Plus

Please fill out the following application to begin the enrollment process for SUNY Orange Plus

Personal Background
Full First Legal Name *
Middle Name *
Full Last Legal Name *
Chosen First Name (only if different from first legal name above)
Other Last Names Used/Maiden Name (only if different from last legal name above)
Phone Phone * - ### - ### ####
Personal Email Address (not "...@sunyorange.edu") *
Permanent Home Address Permanent Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Is your mailing address different from the address listed above? *

Is your mailing address different from the address listed above? Yes No
Mailing Address Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Biographical Information
Birthdate Birthdate * / MM / DD YYYY
Legally Recognized Sex *
Gender Identity *
If you selected "other" please input your gender identity here
Pronouns *
Citizenship & Social Security Information
Primary Citizenship *
Are you a United States Permanent Resident? *
City of Birth *
Country of Birth *
Visa Type (If status/visa is unkown, please enter "other") *
Residency
Has NY State been your legal residence for the past 12 months? *
Have you lived in Orange County for the last six months? *
Program Information
Please select the course you are enrolling in *
Start Term *
Academic Information
Do you hold a high school diploma or GED? *

Do you hold a high school diploma or GED? High School Diploma GED/TASC NY State High School Equivalency (HSE) Diploma
Did you attend high school outside of the United States? *

Did you attend high school outside of the United States? Yes No
Anticipated or Actual GED/TASC or HSE Diploma Month *
Anticipated or Actual GED/TASC or HSE Diploma Year *
High School/College Information

Please input the most recent High School or College/University information.
High School Name *
End Date End Date * / MM / DD YYYY
College/University Name *
Level of Study *
End Date End Date * / MM / DD YYYY
Additional Questions
Have either of your parents graduated from a four-year college of university? *
Have you ever been dismissed from a college for disciplinary reasons? *

Have you ever been dismissed from a college for disciplinary reasons? Yes No
How did you hear about SUNY Orange Plus?

How did you hear about SUNY Orange Plus? Social Media Guidance Counselor SUNY Orange Website From a friend/relative From an internet search Other Other
Accomodations
If you are in need of disability-related accommodations, please check this box
Emergency Contact
Relationship to applicant *
Name Name * First Last
Mobile Phone Number Mobile Phone Number * - ### - ### ####
Applicant Signature
By checking this box, I acknowledge that I understand that withholding information or giving false information may make me ineligible for admission to, or continuation at, the College. Therefore, in submitting this information, I certify that it is true, correct, and complete. Additionally, I understand that upon my enrollment I must abide by the policies and regulations of SUNY Orange. *

By checking this box, I acknowledge that I understand that withholding information or giving false information may make me ineligible for admission to, or continuation at, the College. Therefore, in submitting this information, I certify that it is true, correct, and complete. Additionally, I understand that upon my enrollment I must abide by the policies and regulations of SUNY Orange. Please check here if you have read and agree to the previous statement.
*
Supporting Document Upload
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Application: SUNY Orange Plus

Application: SUNY Orange Plus

Personal Background

Biographical Information

Citizenship & Social Security Information

Residency

Program Information

Academic Information

High School/College Information

Additional Questions

Accomodations

Emergency Contact

Applicant Signature

Supporting Document Upload