***** Retain for your records. Please do not mail.

*****

SUNY Application
for Undergraduate Admission
For Your Records
Date Submitted:

Wilkins

Applicant Name

Last Name

Suffix

Milan

First Name

Applicant Social Security No.

5a Home Phone
6

Ginger India
Middle Name

*********

+1.347-264-2470

Date of Birth

5b Daytime / Cell Phone

12/20/1999

Male

Female

+1.347-264-2470

E-Mail Address

milan.wilkins16@gmail.com
7

Permanent Home
Mailing Address

8719 Eldert Ln
Address Line 1

Address Line 2

Woodhaven

NY

City

114211844

State

Zip / Postal Code

United States
Country (if outside U.S.)

Province (if outside U.S.)

8a Temporary Mailing Address: if completed, mail may be sent by campuses to this address until date indicated in 8b.

Address Line 1

Address Line 2

City

State

Province (if outside U.S.)

Zip / Postal Code

Country (if outside U.S.)

8b Date after which mail may be sent to your permanent address.

9a Are you a U.S. citizen?

 Yes  No

10a Are you a New York State resident?

10c If yes, give county of residence.

9b If not a U.S. citizen, are you a permanent resident of the U.S.?

 Yes  No

 Yes  No

10b If yes, but for less than one year, how many months?

New York
A1

11 Indicate name and address of the parent or guardian with whom you legally reside and to whom official university correspondence should be sent.

Nikima

Vanbeverhoudt
Last Name of Parent or Guardian

First Name of Parent or Guardian

Parent or Guardian E-Mail Address

Nikiblac07@yahoo.com

 if address of parent or guardian is the same as permanent address given on page A1. If not the same, indicate the address below.

Mark here

Parent/Guardian Address
Address Line 1

Address Line 2

City

State

Zip/Postal Code

Country (if outside U.S.)

Province (if outside U.S.)

12 Answer only if members of your family attended or graduated from a State University of New York (SUNY) campus. Please indicate their relationship to you, and provide
their name, graduation year and the State University campus name.

Relationship

/
Last Name

First Name

Graduation Year

SUNY Campus

Relationship

/
Last Name

First Name

Graduation Year

SUNY Campus

$30,000 - $44,999

13 Family Income Range

Required if applying for EOP or financial fee waiver

14 Size of Household
Required if applying for EOP or financial fee waiver

15 Select yes if one or more of the following apply to you:

You are or were in foster care at any time after the age of thirteen.
You are an orphan who was not adopted before the age of thirteen.

Yes

 No

 U.S. Veteran  Dependent of a U.S. Veteran  Active Duty U.S. Military  National Guard or Active Reserve
17a Are you Hispanic/Latino?  Yes  No
16 Indicate if you are:

17b If Hispanic/Latino, is your background (select one):

Central American

Cuban

Dominican

Mexican

Puerto Rican

South American

Other Hispanic/Latino

17c All applicants, please indicate your race (select one or more):

American Indian or Alaska Native - I

18 - 19 Mark

the box if you wish to indicate:

Asian - A
18

Black or African American - B

Your native language is not English

 Native Hawaiian or Other Pacific Islander - P  White - W

19

You are an Adult Learner

Note: All applicants (freshmen and transfer students) MUST answer questions 20a and 20b.
20a Have you been convicted of a felony?

 Yes  No

20b Have you been dismissed, expelled, and/or suspended from a college for disciplinary reasons?

A2

 Yes  No

(Even if you have never attended college,

a response is required.)

21 If you have academic records under another name, please indicate below:

/
Former Last Name

Former First Name

22 Name of High School (Required for all applicants, including transfer students.)

CEEB Code

Young Womens Leadership School of Queens

332592

23 High School Mailing Address

15091 87th Rd
Address

Jamaica

114323311

NY

City

Zip / Postal Code

State

Province (if outside U.S.)

Country (if outside U.S.)

24a Indicate your Secondary Education Status.

Will Graduate

24b Enter date of High School Graduation, High School Withdrawal or completion of high school equivalency diploma.

(List only month and year.)

 Yes  No

24c Have you attended a high school in New York for two or more years?
25 NYC DOE Student OSIS number

06/2017

206454001

Questions 26 and 27 are optional for Adult Learners and International Applicants.
26 Date latest Scholastic Assessment Test (SAT)
was or will be taken. (List only month and year.)

12/2016

27 Date latest ACT was or will be taken.

(List only month and year.)

12/2016

28 Indicate whether you are applying as a Freshman or a Transfer student (mark only one):

 Freshman (You have not taken college-level work after high school graduation.)  Transfer (You have taken college-level work after high school graduation.)
29 If you are applying as a freshman, have you received (or do you expect to receive) college credits before you graduate from high school?
If yes, please mark  all boxes that apply to you:
1
2

 Advanced Placement (AP)

 College Level Examination Program (CLEP)

3
4

 College course taught in high school

 Course taken at a college prior to graduation

5
6

 Yes  No

 International Baccalaureate (IB)

 Other
Please Specify

30 Are you applying for full-time or part-time study?

Full-time

Part-time

Yes
No Note: EOP is a program for New York State residents. All applicants must meet
31 Are you applying for the Educational Opportunity Program (EOP)?
academic and financial eligibility requirements. Please note that when applying for EOP, you must answer questions 10a, 10b, 13, and 14.
Non-U.S. Citizens must complete questions 32-39. If you are not a U.S. citizen, permanent resident, or refugee, your campus choice(s) will ask you to file
additional forms (FSAs 2, 3, and 4), as well as to provide official transcripts.
32 Country of Birth
Country (if outside U.S.)

33 Country of Citizenship
Country (if outside U.S.)

34 If you are a non-U.S. citizen and a permanent resident of the U.S., provide alien registration number.
35 If you are not a permanent resident, have you applied for permanent resident status?

 Yes  No

36 If you are not a permanent resident, indicate your visa type.

37 Visa Expiration Date

38 How many years have

you been in the U.S.?

39 Date latest Test of English as a Foreign

Language (TOEFL) was or will be taken.

A3

All transfer applicants must complete questions 40-51. Please remember to list the college you currently attend in question 44. You will need to provide academic
transcripts for all post-secondary institutions you have attended, whether or not you received credit. Transcripts should be sent directly to the SUNY campus(es) to which you
are applying. SUNY and CUNY campus codes (college codes) are listed on page A8 of the application.
Transfer applicants seeking a fee waiver (up to four campus choices) are required to complete questions 40-51. Failure to answer all questions (40-51)
will delay processing. See page 3 for detailed information.
40 If you have earned (or will earn) an associate degree from a New York State public college before enrolling, indicate the degree by marking

 AA - 1

 AS - 2

 AAS - 3

in the appropriate box below:

 AOS - 4

41 Indicate the date the associate degree was (or will be) earned prior to enrollment.
42 Indicate the campus of the New York State public college (SUNY or CUNY) where the degree was earned.
43 If you are transferring to complete a cooperative program, give the previous Curriculum Code.

44 College 1 - Name/City/State (LIST CURRENT OR MOST RECENT COLLEGE FIRST)

City

Name

Dates Attended

GPA

Total Credits

From:

State

CEEB Code

To:

45 College 2 - Name/City/State

City

Name

Dates Attended

GPA

Total Credits

From:

State

CEEB Code

To:

46 College 3 - Name/City/State

City

Name

Dates Attended

Total Credits

From:

State

GPA

CEEB Code

To:

47 How many colleges have you attended in addition to the three listed above?
48 Mark

the type of college you most recently attended (MARK ONLY ONE):

SUNY - A*

NY Private 2-Year - D

Non-NY Private 4-Year - G

CUNY - B

Non-NY Public 4-Year - E

Non-NY Private 2-Year - H

NY Private 4-Year - C

Non-NY Public 2-Year - F

Outside U.S. - I

*NOTE: If you marked SUNY - A, please forward a General Education Transcript Addendum along with your official transcript directly to each of your campus choices.
Your transcript and transcript addendum can be requested from your registrar.
49 Mark here

if you are (or were previously) enrolled in EOP, College Discovery, HEOP or SEEK.

50 Mark here

if you hold (or will receive) a bachelor's degree prior to enrollment.

51 Indicate the total number of credits you expect to earn from all colleges before enrolling.

A4

Buffalo State College

State University Campus Name

2499
Curriculum Code

(On campus)Childhood Education and English 1-6, 7-9 Eng Ext

Curriculum Name

Semester you wish to enroll:

Fall 2017

for Early Decision*. (Early Decision is an option that may be selected for one campus choice onlyBlock A or B or C.
 See
list below for campuses offering Early Decision*.)
Mark here  for Early Action**. (See list below for campuses offering Early Action**.)
Mark here  for the Educational Opportunity Program at this campus. (See page 6 for eligibility requirements.)
Do you wish campus housing?  Yes  No
If applying to this campus again, when did you first apply?
Mark here

Special Campus Project (Your campus choice

may direct you to use a specific code.)

Oswego, State University College at

State University Campus Name

1557
Curriculum Code

(On campus)Childhood Education (Grades 1-6)

Curriculum Name

Semester you wish to enroll:

Fall 2017

for Early Decision*. (Early Decision is an option that may be selected for one campus choice onlyBlock A or B or C.
 See
list below for campuses offering Early Decision*.)

Mark here
for Early Action**. (See list below for campuses offering Early Action**.)

Mark here
for the Educational Opportunity Program at this campus. (See page 6 for eligibility requirements.)
Do you wish campus housing?  Yes  No
If applying to this campus again, when did you first apply?
Mark here

Special Campus Project (Your campus choice

may direct you to use a specific code.)

Geneseo, State University College at

State University Campus Name

1559
Curriculum Code

(On campus)Early Childhood/Child Ed (Birth-2 & Grades 1-6)

Curriculum Name

Semester you wish to enroll:

Fall 2017

for Early Decision*. (Early Decision is an option that may be selected for one campus choice onlyBlock A or B or C.
 See
list below for campuses offering Early Decision*.)
Mark here  for Early Action**. (See list below for campuses offering Early Action**.)
Mark here  for the Educational Opportunity Program at this campus. (See page 6 for eligibility requirements.)
Do you wish campus housing?  Yes  No
If applying to this campus again, when did you first apply?
Mark here

Special Campus Project (Your campus choice

may direct you to use a specific code.)

Old Westbury, State University College at

State University Campus Name

1557
Curriculum Code

(On campus)Childhood Education (Grades 1-6)

Curriculum Name

Semester you wish to enroll:

Fall 2017

Early Decision*. (Early Decision is an option that may be selected for one campus choice onlyBlock A or B or C.
 for
See list below for campuses offering Early Decision*.)
Mark here  for Early Action**. (See list below for campuses offering Early Action**.)
Mark here  for the Educational Opportunity Program at this campus. (See page 6 for eligibility requirements.)
Do you wish campus housing?  Yes  No
If applying to this campus again, when did you first apply?
Mark here

Special Campus Project (Your campus choice

may direct you to use a specific code.)

A5

A6