College in High School Application and Course Selection Form

Thank you for your interest in College in the High School. Please complete and submit the below form. Make sure to complete the course selection on the bottom of this page. Any questions do not hesitate to reach out ot the Educational Pathways Office, educationalpathways@cobleskill.edu.

* Required

Student Information

First Name

Middle Name

Last Name

Chosen First Name

Personal Pronouns

He/Him/His

She/Her/Hers

They/Them/Theirs

Social Security Number

Birthdate (Month/Day/Year)

Legal Sex

Female

Male

Gender Designation

Female

Male

Nonbinary

Permanent Home Address (include PO Box/ apartment number as appropriate)

Country

Street

City

Region

Postal Code

Home Phone

Daytime Phone (if different)

Email Address

Are you a US Citizen?

Yes

No

Are you a New York State Resident?

Yes

No

If your principal or permanent home has not been in New York State for a 12-month period immediately prior to the date you intend to enroll, you willbe considered an out-of-State student for tuition purposes. Please note that if you are financially dependent and your custodial parent lives in a state other than New York State, you will be considered a resident of that state.

County of Residence

Your response to the following racial/ethnic question is voluntary, but federal civil rights legislation and implementing regulations require the University to submit counts of its student body by racial/ethnic categories. Your cooperation, therefore, while voluntary, is essential to the accurate reporting of this information.

Academic Information

Have you previously been enrolled in SUNY Cobleskill College in the High School?

Yes

No

Semester you wish to enroll

Full-year

Fall

Spring

Year you wish to enroll

2024

2025

2026

High School Name

ceeb

Currently enrolled grade

Expected Date of Graduation

Signature

I understand that this application cannot be processed if it has not been completed according to instructions and that all information submitted is true to the best of my knowledge. Any deliberate falsification or omission of data may result in denial of admission or in dismissal.

Please type your name in place of your signature.

Course Selection

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Course selection
Course prefix and number (Example: ENGL 101) Course Title (Example: Composition) Credits (Example: 3)

Add course

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College in High School Application and Course Selection Form