Nonmatriculated And Visiting Student Registration Form - Graduate - St. John'S University - New York Page 2

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Religious Affiliation
Please check one:
Baptist
Islamic
Mormon/LDS
Russian Orthodox
Other _____________________
Buddhist
Jehovah’s Witness
Pentecostal
Seventh Day Adventist
__________________________
Episcopal
Jewish
Presbyterian
Sikh
__________________________
Greek Orthodox
Lutheran
Protestant
Non-Denominational
__________________________
Hindu
Methodist
Roman Catholic
None
__________________________
Educational Background
Name of College/University
City
State
From (Month/Year)
To (Month/Year)
Graduation Date or
Expected Graduation Date
Courses to be Taken at St. John’s
Please indicate courses in order of preference. For a list of available courses, please visit stjohns.edu/courses.
Subject
Course Number
Course Reference
Credit Hours
Summer Session Only
Number [CRN]
Pre
Summer I Summer II
Post
Fall
Spring
Previous Dismissal or Suspension
Have you ever been disciplined for misconduct, suspended, expelled, or required to withdraw from any secondary or
postsecondary educational institution? If yes, please explain on a separate sheet of paper.
Yes
No
Have you been convicted of a felony? If yes, please explain on a separate piece of paper.
Yes
No
Your Signature
I, the undersigned, hereby apply for admission to St. John’s University. If accepted, I agree to abide by all the rules and regulations of the
University, including those set forth in the University bulletins. All information contained herein is, to the best of my knowledge, true
and complete. (Any omission or falsification of records is grounds for dismissal.)
__________________________
Signature _________________________________________________________
Date (Month/Day/Year)
Certification
Certification for Students Enrolled in Other Institutions of Higher Education (Visiting Students Only)
This is to certify that _____________________________________ is in good standing at _________________________________ and
(Student Name)
(Name of Institution)
has permission to register for the courses listed above.
_________________________________________________
_________________________________________________
(Signature of Dean/Registrar)
(Title)
For more information, please visit our website at stjohns.edu/visitingstudents or call 1-888-9STJOHNS or 718-990-2000.
M1-10490/LR
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DOC TYPE: APP_G
2

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