Non-Credit Course Registration Request Form

Non-Credit Course Registration Request Form
Please note: This form may only be used for the Summer 2020 Continuing Education non-credit professional development and 5-hour pre-licensing courses (view applicable courses here). If you'd like to register for Summer Enrichment, please use this form instead. For online Ed2go courses, please register and pay directly through the Ed2go website for short-term fundamentals courses or career training certificate programs.

Thank you for your interest in SUNY Adirondack’s Continuing Education programs. Submitting this form authorizes our office to register and bill the individual listed on this form for the specified non-credit course(s). If additional information is needed for us to register you for a course, or if a class you’d like to sign up for is no longer accepting registrations, we will contact you as soon as possible. Please note:
- This form can only be used to register the individual whose information is listed below. This form must be submitted by the individual listed below, or by their parent/guardian, significant other, or sponsoring employer. Please submit your request and fill out the form again for any additional students you'd like to register.
- To request a non-credit course registration for an individual under 17 years of age, please don't use this form - email conted@sunyacc.edu or call our office at 518.743.2238.
- Our registration, course cancellation and drop/refund policy can be found here: http://www.sunyacc.edu/continuing-ed/registration
Student Name *

Legal First Name Middle Name Last Name
Birth Date *

Month Day Year
Banner ID or SSN
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Home or Cell Phone Number *

Area Code Phone Number
Work Phone (optional)

Area Code Phone Number

Please list the course(s) for which you would like to register.

Please note that you will automatically be billed for these course(s) once your registration has been processed by Continuing Education staff. If a course is unable to take registrations, or if additional information is needed to process your registration, Continuing Education staff will contact you by phone or email as soon as possible.

Course Title

CRN

Course Start Date

Additional Comments (if applicable)
IMPORTANT - Please read the following, then click the "Submit" button below to submit your registration request. Contact the Office of Continuing Education at 518.743.2238 or conted@sunyacc.edu with any questions.
- The information submitted in this form will be used by Continuing Education staff to register the individual listed on this form for the course(s) specified.
- Once you have been officially signed up for the class in the College’s registration system, Continuing Education staff will send you a confirmation by email or phone, as well as send a hard copy of the confirmation and bill to your mailing address.
- If a course is full and unable to take additional registrations , or if we need to clarify additional details to finalize your registration, we will contact you by phone and/or email as soon as possible.
- Please note that you will be automatically billed via mail for the course(s) once your registration has occurred. Details on our refund/bill adjustment policy and how to pay course fees are available at: https://www.sunyacc.edu/continuing-ed/registration
By clicking the submission button below, I confirm that I am the individual listed on this form, or their parent/guardian, or their significant other, or a sponsoring employer.
Should be Empty: