SCCC Enrollment Services Offices will be open Saturday January 28 from 8:30 am -12:30 pm. These hours are in addition to our standard office hours.

Non-Degree Student Application Form

You can be assured that all information is encrypted and transmitted securely.

Your Social Security Number is used to coordinate the collection of information for all your student records. Authority to collect the Social Security Number is granted under Section 355 of the New York Education Law.

Instructions

  • Complete all the required information below.
  • Press "Reset" to correct your application.
  • Press "Send" to submit your application.

Personal Information

First Name MI Last Name
Date of Birth     Former Name
SS #     Gender Male      Female
Home Phone ( )     Cell Phone ( )
Email

Mailing Address

My mailing address is the same as my permanent address.
 
Address City
State Zip
County Country

Permanent Address (P.O. Box is not an acceptable address)
 
Address City
State Zip
County Country

Please Indicate Your Location and Semester

Ammerman Campus   Eastern Campus   Grant Campus   Sayville Downtown Center
Fall      Winter      Spring      Summer

Please Indicate Your Status

NY State resident for prior 12 months Yes   No   U.S. Citizen Yes   No
Suffolk County resident for prior 6 months Yes   No   Veteran Yes   No
Will you be attending SCCC while attending high school? Yes   No
Have you ever been convicted of a felony? Yes   No
Have you ever been suspended from college for disciplinary reasons? Yes   No

School Information

High School
College

Ethnicity/Race (for statistical purposes only)

Are you Hispanic/Latino? Yes      No
If Hispanic or Latino, please indicate your ethnicity (select one)
All applicants please indicate your race (select one or more)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Additional Information or Comments - Please enter below: