Visiting Student Application

含羞草传媒 Visiting Student Scheduling/Course Request Form

Applying for *

Summer 2026 (May Start Date)

Fall 2026 (August Start Date)

Winter 2027 (Decemeber Start Date)

I have taken 含羞草传媒 courses and/or ACE courses before:

Yes

No

First Name*

Last Name*

Former Name

Mailing Address*

City*

State*

Zip*

County*

Telephone*

Cell Phone*

Email*

Gender*

Date of Birth (mm/dd/yyyy)*

Are you a US Citizen*

Yes

No

Are you Hispanic/Latino

Yes

No

If Hispanic/Latino, is your background (check one)

Central American

Dominican

Mexican

Other Hispanic/Latino

Puerto Rican

South American

Other applicants (select one or more)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

High School Information*

Graduated or will graduate from high school. Put 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 nor earn a state high school equivalency diploma. Please call to discuss options.

Homeschooled. Put graduation date below.

Graduation/GED date*

High School currently attending or last attended*

Program of interest

Do you plan to earn a degree from 含羞草传媒?

Yes

No

Last date attended 含羞草传媒(if applicable)

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

Other colleges attended(if applicable)

For those under 21 years of age, please provide name & address of parent/guardian

Indicate the classes you will be taking at 含羞草传媒 for the indicated semester on this application*For each class, on a new line, please provide subject, course number, section, title, CRN, and credits (Example ENGL 1010-001 College Composition I CRN: 12465 Credits: 3)

VISITING STUDENT RESPONSIBILITIES

I understand that all academic and financial responsibilities must be met by the beginning of the semester. I also understand that my signature is binding and I must make any changes using the proper procedures and forms for this institution. Failure to do so may result in academic and/or financial liability and/or penalty. If under the age of 18, parent or guardian signature is needed. My signature indicates that I have read, understand and agree to abide by the above terms.

All students registered for 6 credit hours or more in classes physically located on the Corning/Elmira campuses or other MUST submit:

NEW YORK STATE LAW: MMR REQUIREMENTS Records may be located at your previous college, high school or family doctor’s office. In accordance with NYS Law any student born after January 1, 1957, must provide proof of immunity to measles, mumps, and rubella, this requirement may be met by the following: Proof of disease, immune titers, or two (2) measles, one (1) mumps, and one (1) rubella vaccine given after the student’s first birthday).

NEW YORK STATE LAW: MENINGITIS VACCINE The Center for Disease Control Advisory committee on Immunization Practices (ACIP) recently issues a new recommendation for college students registered for 6 credit hours or more: Students, especially those living in residence halls, should consider vaccination to reduce their risk for MENINGOCOCCAL DISEASE. New York State Public Health Law 2167 requires:

A response to receipt of meningococcal disease and vaccine information signed by the student or student’s parent or guardian (if under the age of 18). AND EITHER
A record of meningococcal meningitis immunization within the past 3-5 years; OR
An acknowledgment of meningococcal disease risks and refusal of meningococcal meningitis immunization waiver signed by the student or student’s parent or guardian (if under the age of 17).

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 含羞草传媒. I understand that by submitting this application, I will be contacted by 含羞草传媒 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. 含羞草传媒 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 first name*

Signature last name*

Date*