•
•
Visiting Student Registration Form
Undergraduate
Please read the instructions below carefully and complete the entire application.
Submit this form to the Office of the Registrar.
• In order to register, this form must be signed by a dean or registrar on side 2.
Completed form may be sent via fax to 718-990-1677, via e-mail (for scanned copy) to
visitingstudent@stjohns.edu, or via mail to:
St. John’s University
Office of the Registrar
Newman Hall, Room 106
8000 Utopia Parkway
Queens, NY 11439
Important: Please type or print clearly.
Social Security Number (Optional)
Date of Birth (Month/Day/Year)
I am applying as a visiting student for the
Queens campus
Staten Island campus
8000 Utopia Parkway
300 Howard Avenue
Queens, NY 11439
Staten Island, NY 10301
I plan to start in
Fall 20
(September)
Spring 20
(January)
Summer 20
Applicant’s Last Name (Surname)
First Name (Given Name)
Middle Name
Address (Number and Street Address)
Apartment No.
City
State/Province
Zip/Postal Code
Country
Home Telephone (Include Area Code)
Work Telephone (Include Area Code)
E-mail Address
Gender
Male
Female
Have you previously attended St. John’s University?
Yes
No
Ethnic Origin (Optional)
Please check one:
Hispanic or Latino
Not Hispanic or Latino
Select one or more categories to indicate what you consider yourself to be:
American Indian or Alaskan Native
Black or African-American
Hispanic
Native Hawaiian
or Other Pacific Islander
Native American or Alaskan Native
Black, African-American
Hispanic, Cuban
Native Hawaiian
Black, African
Hispanic, Mexican
Asia
Pacific Islander
Black, Caribbean/West Indian
Hispanic, Puerto Rican
Asian or Far East
White
Black, Other
Hispanic, South/Central American
Indian Subcontinent
Arab, N. African, Middle East
Hispanic, Other ________________
Asian, Other __________________
Caucasian, All Other Heritage
M1-10465/LR
•
•
•
•
DOC TYPE: APP_UG
1