Application for Non-Degree Students

Personal Information
Last First M.I.
Permanent Address
Street Street 2
City State Zip Code
County Country of Citizenship
Country of Birth Citizenship Status
Visa Type (If Applicable)
Gender, Birth, Ethnicity
Date of Birth
Are you Hispanic/Latino? Yes No
If Hispanic/Latino, what is your background
All Applicants, please indicate your race (select one or more)
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander
Contact Information
Daytime Phone Number ()- Evening Phone Number ()-
Email Address:
High School and Previous Coursework
Semester you want to enter Buffalo State: Year    Term
Have you completed any previous Buffalo State coursework? Yes No
Do you plan to audit any courses? Yes No
Have you completed any previous coursework at another college? Yes No
Have you graduated from high school or received your GED? Yes No
If no, what is your expected date of graduation?
Have you ever been:   
A) Dismissed from a college for disciplinary (NOT academic) reasons?Yes No
B) Dismissed from a college for academic reasons?Yes No
If yes, When/for how long?
Indicate if you are one of the following:
U.S. Veteran (A Veteran is a person who has served in the U.S. Armed Forces)
Dependent of a U.S. Veteran (Dependent is defined as either spouse or child)
Military Service Member (Active Duty, Reserve, or National Guard)
Dependent of a Military Service Member (Dependent is defined as either spouse or child)
I am enrolling as a Buffalo State student because I am
I understand that my current registration is for non-degree undergraduate study and that my enrollment does not guarantee my admission as a degree seeking student. In order to matriculate, I must file a formal application with the appropriate admissions office and meet admissions requirements.
The information on this form is accurate and complete to the best of my knowledge. The University reserves the right to validate the information at any time and, if found fraudulent, to take necessary actions. I understand that a permanent transcript of my work as a non-degree student will be maintained at Buffalo State and that I am responsible for all tuition and fees that will result from registering for courses at the college.
By checking this box I agree that all the above is true