06/2024
Non-Degree Students are those who do not intend to pursue a degree or certicate at NCC but rather, plan to take courses for personal enrichment, for transfer to another college
or professional growth. Students must complete an application for admission, provide required documentation and pay the application fee. Check out the Class Schedule for class
availability, and select the semester for which you are planning on enrolling. There is a non-refundable application fee charged.
Admission Semester being Requested:
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Summer 20
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Fall 20
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Winterim 20
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Spring 20
Social Security Number – – Date of Birth: / / (MM/DD/YYYY)
(Enter your United States of America Social Security Number (SSN). Your SSN is used to coordinate the collection of information for all your student records. Authority to collect the
SSN is granted under Section 355 of the New York Education Law. Your response will be held condential. Please double check the number for accuracy.)
Name: Legal Last (Family) _______________________________________________________ Legal First ______________________________________ Middle ___________________________
Preferred First Name ____________________________________________ The College reserves the right to: a) deny a request for chosen name based on its
unsuitable nature (i.e., the use of profane, obscene, hate-speech-derived, offensive or derogatory names), and b) remove any chosen name from College records without prior
notice to the individual.
Previous Legal Name(s): ________________________________________________________________________________________________________________________________________
Permanent Address: (Po. Box cannot be used as perm. address) _______________________________________________________________________ Apt. # _________________________
City _____________________________________________________ State __________________ Zip _______________ If other than the U.S.A., specify COUNTRY ____________________________
Mailing Address ______________________________________________________________________________________________________________________________________________________
How long have you resided in Nassau County?
____________________ Years How long have you resided in New York State? _______________ Years
Cellular Number: (
_________ ) _____________ – ________________ Home Number: ( _________________ ) ______________ – _______________
Personal email address: _______________________________________________________ Conrm your email address: __________________________________________________
Legal Sex:
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Male
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Female
Gender*:
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Male
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Female
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Non-Binary
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Other ________ d) Pronouns*:
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He/Him
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She/Her
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They/Them
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Other________
Citizen of the United States of America:
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Yes
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No
If not a USA Citizen of the U.S.A, what is your Country of Citizenship/Birth?
__________________________________________
AND check your status below
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Legal permanent resident of the United States (Attach a copy of your permanent resident card)
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Have a visa (please identify) A, B, E, F, G, H, K, L, M, N, O, P, R, S, T, U, V (Attach a copy)
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Status Pending_____________________________________________________________________________
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Other (specify)
____________________________________________________________________________
Ethnicity (optional): Are you Hispanic/Latino?
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Yes
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No
If you are Hispanic/Latino, is your background (select one)
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Central American
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Cuban
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Dominican
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Mexican
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Puerto Rican
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South American
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Other Hispanic/Latino
Race (optional):
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White
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Black or African American
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Asian
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Native Hawaiian or other Pacic Islander
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American Indian or Alaskan Native
Have you ever been suspended from any college for disciplinary reasons?
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Yes
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No
If you answered “Yes” to this question, you must submit a Request for Admissions Review form to the Registrar’s Ofce.
PROOF OF GRADUATION
High School:
Graduation Date:
If your school is outside of New York, list the state or if outside of the U.S.A., list country
If you received a high school equivalency (HSE), formerly known as the GED, please include diploma date: / / (MM/DD/YYYY)
COLLEGES/UNIVERSITIES ATTENDED:
School name, city and state, (specify country if outside the U.S.A.)
Dates Attended
From To
Date of Graduation
MM/DD/YYYY
Degree
Declaration
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By checking this box, I declare that all statements made in this application are, to the best of my knowledge, true and correct, and that reporting any information on this application inaccurately
can result in the revocation of an offer of admission. I understand that if I was born on or after January 1, 1957, I must provide the College with proof of immunization against measles, mumps and rubella, prior to
the 30th day of the semester. ALL students, regardless of age, must ll out the meningitis survey, which is available at www.ncc.edu/healthservices. My failure to comply with this New York State law NO LATER
THAN 30 days from the start of the semester will result in my disenrollment from classes without refund of tuition and fees.
In addition, with respect to tuition and fees, the College may refer all amounts in arrears to a collection agency or litigate to ensure payment, and I will be responsible for payment of all attorneys’ fees, reasonable
collection costs and other charges necessary for collection of any amount not paid when due. Further, I understand that the College may have such default information forwarded to credit reporting agencies.
Students with overdue tuition and fees may be referred to a collection agency and will incur additional liabilities of up to 33% to cover all associated collection costs processes. Further, I understand that the College
may have such default information forwarded to credit reporting agencies.
By providing your mobile number you are giving permission to the College to send you text message notications.
Student Signature
Date
Nassau Community College is a comprehensive, full-opportunity College, open to all qualied applicants without regard to age, race, color, religion, marital status, national origin or disability.
NON-DEGREE SEEKING APPLICATION
FOR OFFICE USE ONLY:
OFFICE OF THE REGISTRAR
One Education Drive
Garden City, NY 11530
www.ncc.edu