Application | Corning Community College

Applying for *

Spring 2019 (January start)

Summer 2019 (May start)

Fall 2019 (August start)

Student Type *

First Time at any college

Transfer from another college

Former SUNY CCC student

I want to enroll *

Full-Time (12 credit hours or more)

Part-Time (less than 12 credit hours)

Non-degree (Please note that non-degree students are not eligible for financial aid or for graduation. Non-degree students do not need to request official transcripts for matriculation (admission acceptance) purposes.

First Name *

Last Name *

Former Name

If you have records under a different name, give former name(s)

Mailing Address *

City *

State *

Zip *

County *

Telephone *

Cell Phone *

Email *

Gender

Date of Birth (mm/dd/yyyy) *

Citizenship

Are you a US Citizen *

Yes

Veteran Information

Are you a veteran of the US Armed Forces?

Yes

Are you eligible for the G.I. Bill/VA Education Benefits?

Yes

Are you a spouse/dependent (child) of a Veteran and eligible for VA Education benefits?

Yes

Disciplinary Dismissal Information

Have you ever been dismissed from a college for disciplinary reasons (not academic)?

Yes

Career/Education Goal

What are your career and educational goals?

Has anyone in your immediate family completed a college degree?

Yes

High School Information

You must request an official transcript. Please see www.corning-cc.edu/apply for more information *

Graduated or will graduate from high school. Put graduation date below

Did not graduate from high school but earned a State High School Equivalency Diploma [GED/TASC]. Put date below.

Did not graduate from high school or earn a State High School Equivalency Diploma [GED/TASC] (see catalog for restrictions on admission to college)

Homeschooled. Put graduation date below.

Graduation/GED date *

High School currently attending or last attended *

High School mailing address (include street, city, state, zip) *

Previous College Information

Name and Address of Previously Attended College

Name and Address of Previously Attended College (additional)

You can contact my High School Counselor for Admissions-Related Info *

Yes

Release and Signature: The information provided in this application is correct to the best of my knowledge. The high school named in this application has my permission to release requested records to SUNY Corning Community College. I understand that by submitting this application, I will be contacted by SUNY Corning Community College for the purposes of beginning the enrollment process, which may include missing documentation, scheduling assessment testing, reminder calls for appointments, scheduling registration appointments, follow up communication to assist the student with enrolling in classes and preparedness for the first day of classes. SUNY Corning Community College will communicate to students through traditional communication, as well as email, automated calling, and text messaging. You will need to let the Office of Admissions know if there is a method in which you do not want to be communicated with.

Signature *

Date *

The Personal Privacy Protection law requires this notice to be provided when collecing personal information from individuals. The information on this application will be used to evaluate your request for admission. The application information will be maintained in the Admissions and the Registration and Records offices. The official responsible for maintenance of this information is the Vice President and Den of Enrollment Management and Student Development. SUNY Corning Community College is an equal employment and educational opportunity institutation, and does not discriminate on the basis of race, color, creed or religion, gender, sexual orientation, national origins, age or physical or mental disability, or other factors which cannot be legally used as the basis for employment or educational decisions.