Visiting Student Registration Request

All fields with * are required.

First Name*
Middle Initial
Last Name*
Gender*
Address*
City*
State*
Zip*
Birthday (MM/DD/YYYY)*
Social Security (Last 4 digits only)*
Phone*
Email*
Ethnic Background: (This information is voluntary and for statistical purposes only. It has no bearing on your ability to register for classes at Southern Connecticut State University.)
Ethnicity (Select all that apply)	Control/Command + Click to select/deselect.
U.S. Citizen/Permanent Resident*

Have you attended Southern before?*
Year (If attended Southern)
Name (If under a different name)
Highest level of completed education*
Are you currently attending another institution?*
If yes, what institution?
Which semester do you intend to register for?
Semester*
Year*