Course Audit Registration Form printable pdf download

SUNY Polytechnic Institute Registrar’s Office

Course Audit Registration Form

100 Seymour Road, Utica, New York 13502

Instructions: This form is to be completed by students wishing to audit a course. Students may register on the first day of classes

through the last day to add only. Online and hybrid courses are not available for audit. Ability to audit is based upon seat avail-

ability as determined no earlier than the first day of classes for the term. Please complete all information requested below and submit

this form with the required signatures to the Registrar’s Office no later than the end of the last day to add courses for the semester.

Student Name

: _______________________________________________________________

(First,Middle Initial,Last)

Address: __________________________________________________________________________________

_________________________________________________________________________________________

E-mail Address: ____________________________________________________________________________

Date of Birth: ______________________________ Male: ______ Female: ______

Required Information

Have you ever been convicted of a felony? ❏ Yes ❏ No

Have you ever been dismissed from another college for disciplinary reasons? ❏ Yes ❏ No

(Answering “yes” to the questions listed above will not automatically prevent enrollment; the institution may use this information to ensure campus safety. An

applicant who responds “yes” will be requested to provide further information for consideration. The information will be reviewed bye a campus committee. Any

deliberate falsification or omission of data may result in denial of enrollment or dismissal.)

Course Information: ❏ Fall ❏ Spring ❏ Summer Year 20 __

Program/Major(if applicable): ________________________________________________________________

Course Abbreviation, Number & Section: _______________________________________________________

Course Title:________________________________________________________________________________

Day and Time: ____________________________________________________________________________

Building and Room Location: _________________________________________________________________

Student Signature: ______________________________________Date: ______________________________

Note:

Students auditing a course do not pay tuition or fees for the course; their names do not appear on the class roster; and

no credit or grade is received by the student.

A student may only register to audit a course on the first day of classes through the last day to add a course for the term.

Hybrid and online courses are not available for auditing. Signatures indicate approval.

Signature of instructor: ___________________________________Date: ______________________________

Distribution by Registrar’s Office White - Registrar

Yellow - Instructor Pink - Student

Rev: 2/16

Course Audit Registration Form

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