Fall 2025 SUNY Orange Health Profession Application

Student Information
Legal name: Legal name: * First Middle Last
Preferred Name Preferred Name First Middle Last
Has your last name changed?

Has your last name changed? No, I have always had the same last name. Yes, my last name has changed.
Previous Last Name: *
Are you currently enrolled at SUNY Orange as a degree seeking student? *

Are you currently enrolled at SUNY Orange as a degree seeking student? Yes No
Where did you hear about SUNY Orange, or see us advertised? (Please check ALL that apply)

Where did you hear about SUNY Orange, or see us advertised? (Please check ALL that apply) Radio/Streaming Music commerical (please select from list below) Newspaper ad (please select from list below) TV commercial (please select from list below) Social Media ad (please select from list below) Postcard to you from the College Email to you from the College My High school (guidance office, flyer, event) Video ad playing before an online video Mobile App Banner Banner on a Website Google search for local colleges, degrees, or education Billboard Community Event Word of Mouth Other Other
Radio Station:

Radio Station: WRRV-FM WEOK-AM (Juan Radio) K104.7 FM (WSPK) Spotify Other Other
Newspaper:

Newspaper: 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 Port Jervis Gazette Southern Ulster Times Wallkill Valley Times Warwick Advertiser Warwick Valley Dispatch Pike County Dispatch Pike County Courier Other Other
TV commercial on:

TV commercial on: Cable TV Hulu
Social Media:

Social Media: Facebook Instagram Snapchat Twitter
Student ID A# (if known):
Must be 9 characters. Currently Entered: 0 characters.
Please select ONE Health Profession program you would like to be considered for. YOU MAY ONLY BE CONSIDERED FOR ONE PROGRAM *

Please select ONE Health Profession program you would like to be considered for. YOU MAY ONLY BE CONSIDERED FOR ONE PROGRAM Dental Hygiene Fall Day Nursing Fall Evening Nursing Medical Laboratory Technician Occupational Therapy Assistant Physical Therapist Assistant Radiologic Technology
Would you like to be considered for dual admission to Empire State University's RN to Bachelor of Science in Nursing?

Students who complete their A.A.S in Nursing and pass the NCLEX will not need to complete another application at SUNY Empire. Once an official college transcript showing completion of the A.A.S in Nursing and a copy of RN license or passing score on the NCLEX is received in SUNY Empire’s Admissions Office, the student will be notified of next steps to enroll in the RN to BSN program. For more information about SUNY Empire’s RN to BSN program please visit RN to B.S. in Nursing | Empire State University (sunyempire.edu).

Would you like to be considered for dual admission to Empire State University's RN to Bachelor of Science in Nursing?

Students who complete their A.A.S in Nursing and pass the NCLEX will not need to complete another application at SUNY Empire. Once an official college transcript showing completion of the A.A.S in Nursing and a copy of RN license or passing score on the NCLEX is received in SUNY Empire’s Admissions Office, the student will be notified of next steps to enroll in the RN to BSN program. For more information about SUNY Empire’s RN to BSN program please visit RN to B.S. in Nursing | Empire State University (sunyempire.edu). Yes No
Legal address
Please provide your legal address: Please provide your legal address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County: *
YEAR(s) at Legal Address *
Maximum of 2 digits allowed. Currently Entered: 0 digits.
MONTH(s) at Legal Address *
Maximum of 2 digits allowed. Currently Entered: 0 digits.
Is your mailing address the same as your legal address? *

Is your mailing address the same as your legal address? Yes No
Mailing address
Please provide your mailing address: Please provide your mailing address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous address
Please provide your previous address Please provide your previous address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County (previous address):
Length of time at previous address:
Phone Number: Phone Number: - ### - ### ####
Email Address: *
Please provide the following:
Date of Birth: Date of Birth: * / MM / DD YYYY
Legal Sex *

Legal Sex Male Female Other
Gender Indentity: *

Gender Indentity: Male Female X Other
Are you Hispanic or Latino?

Are you Hispanic or Latino? Yes No
Is your background (select ONE): *

Is your background (select ONE): Central American Dominican Mexican Puerto Rican South American Cuban Other Hispanic / Latino
Select all that apply:

Select all that apply: Asian American Indian or Alaskan Native Black / African American Native Hawaiian or Pacific Islander White
Veteran Status: *

Veteran Status: U.S. Veteran Dependent of a U.S. Veteran Active Duty Military None of the Above
Citizenship Status: *

Citizenship Status: U.S. Citizen U.S. Permanent Resident International Student
If you are a U.S. Permanent Resident, you must provide your Alien Registration Number below. *
If you are an International Student, Please indicate your Visa type. (If you are applying for, or have a Student Visa, check F1 below). *

If you are an International Student, Please indicate your Visa type. (If you are applying for, or have a Student Visa, check F1 below). F1 J1 H4 Other Other
If you are an International Student, please indicate your country of birth and citizenship.
Country of Birth: *
Country of Citizenship: *
Have you been dismissed or suspended from a college for disciplinary reasons? *

Have you been dismissed or suspended from a college for disciplinary reasons? Yes No
Secondary Education
Indicate your secondary educational status: *

Indicate your secondary educational status: Graduated from high school Will graduate from high school Home schooled Completed GED
Please provide date of high school graduation: Please provide date of high school graduation: * / MM / DD YYYY
Please provide anticipated date of high school graduation: Please provide anticipated date of high school graduation: * / MM / DD YYYY
Please provide date of home school graduation: Please provide date of home school graduation: * / MM / DD YYYY
Please provide date of GED completion: Please provide date of GED completion: * / MM / DD YYYY
High School Information
Are you attending or did you attend an International High School? *

Are you attending or did you attend an International High School? I attended or am attending a High School in the USA. I attended or am attending a High School outside of the USA (International High School).
Provide the name, city and state of your high school.
Provide the name and city of your high school.
High school name: *
High school city: *
High school state (please choose from the list below): *
Are you attending or did you attend an international college?

Are you attending or did you attend an international college? I attended or attended a College in the USA I attended or am attending a college outside of the USA (International College)
Higher Education
Have you completed any college credits? If so, how many different colleges did you attend? (Please choose the appropriate answer from the menu below.) *
Please list the colleges you attended, with city, state, and number of credits:
College 1
Name of college 1: *
City 1: *
State 1: *
Credits 1: *
College 2
Name of college 2: *
City 2: *
State 2:
Credits 2: *
College 3
Name of college 3: *
City 3: *
State 3: *
Credits 3: *
College 4
Name of college 4: *
City 4: *
State 4: *
Credits 4: *
College 5
Name of college 5: *
City 5: *
State 5: *
Credits 5: *
College 6
Name of college 6: *
City 6: *
State 6: *
Credits 6: *
College 7
Name of college 7: *
City 7: *
State 7: *
Credits 7: *
Previous Health Professions Educational Experience
Have you ever been enrolled in a Health Profession Program at the Associate's Degree level or higher (either at SUNY Orange or another college): *

Have you ever been enrolled in a Health Profession Program at the Associate's Degree level or higher (either at SUNY Orange or another college): Yes No
Please explain why you didn't complete this Health Profession Program:
Please check the boxes below to acknowledge that you have already completed or intend to complete, the following Health Profession Program application requirements:
Pre-admission seminar: *

Pre-admission seminar: I will be completing (or have already completed within 2 years) (Nursing) or 3 years (for all other Health Profession Programs) the required SUNY Orange Health Profession Seminar. (Please note that you MUST email the certificate of completion for Nursing & PTA to the Admissions Office to apply@sunyorange.edu on or before February 1st, 2025). For a complete list of our pre-admission seminar requirements, please visit: https://sunyorange.edu/admissions/health_professions/healthforms.html
TEAS Test (Nursing Program only): *

TEAS Test (Nursing Program only): I will be taking (or have already taken within 2 years of the application deadline) the ATI TEAS Test. ATI TEAS exam results must be emailed to the office of admisisons to apply@sunyorange.edu on or before February 1, 2025
Background Check *

Background Check State University of New York policy prohibits SUNY Orange admission applications from inquiring into an applicant's prior criminal history. After acceptance, the College shall inquire if the student previously has been convicted of a felony if such individual seeks participation in clinical or field experiences, internships or study abroad programs. The information required to be disclosed shall be reviewed by a standing campus committee consistent with the legal standards articulated in NY State Corrections Law.
COVID-19 Vaccination requirements for clinical settings and external organizations *

COVID-19 Vaccination requirements for clinical settings and external organizations COVID-19 vaccination, including vaccine booster, may be required for students enrolled in health professions programs (Dental Hygiene, Medical Laboratory Technology, Nursing, Occupational Therapy Assistant, Phlebotomy, Physical Therapist Assistant and Radiologic Technology) whose academic progress depends on clinical placement. Each clinical partner agency sets its own requirements for students. At this time, all major clinical partner agencies and external organizations with whom the College has clinical agreements are able to rearrange clinical placements for students who refuse or are unable to meet a clinical agency’s vaccination requirement. Failure to meet clinical education outcomes will hinder students' ability to complete their degree program. For more information, please visit: https://sunyorange.edu/wellness/health-professions-students.html
Please provide an emergency contact:
Emergency contact name: Emergency contact name: * First Last
Emergency contact phone: Emergency contact phone: * - ### - ### ####
Emergency contact relationship to you: *
I certify that all information supplied on this application is accurate and complete. My electronic signature below acknowledges that I have read and accepted the admissions requirements for the Health Profession Program.
Signature: *
Date of submission: Date of submission: * / MM / DD YYYY

Fall 2025 SUNY Orange Health Profession Application

Fall 2025 SUNY Orange Health Profession Application

Student Information

Legal address

Mailing address

Previous address

Please provide the following:

If you are an International Student, please indicate your country of birth and citizenship.

Secondary Education

High School Information

Provide the name, city and state of your high school.

Provide the name and city of your high school.

Higher Education

Please list the colleges you attended, with city, state, and number of credits:

College 1

College 2

College 3

College 4

College 5

College 6

College 7

Previous Health Professions Educational Experience

Please check the boxes below to acknowledge that you have already completed or intend to complete, the following Health Profession Program application requirements:

Please provide an emergency contact:

I certify that all information supplied on this application is accurate and complete. My electronic signature below acknowledges that I have read and accepted the admissions requirements for the Health Profession Program.