OFFICE OF SHUSTER HALL, RM 161 PHONE: 718-960-8700 
UNDERGRADUATE 250 BEDFORD PK BLVD WEST FAX: 718-960-8712 
ADMISSIONS BRONX, NY 10468 www.lehman.edu 

UNDERGRADUATE APPLICATION FOR NON-DEGREE STATUS 


HAVE YOU PREVIOUSLY ATTENDED LEHMAN COLLEGE AS A MATRICULATED STUDENT, AND DID NOT GRADUATE? 
IF YES, DO NOT COMPLETE THIS FORM. YOU MUST COMPLETE THE APPLICATION FOR READMISSION. 


Semester Applying For: . 
Fall 20____ . 
Spring 20____ . 
Summer 20____ 
The non-refundable application fee is $65.00 (check or money order only) 


Last Name 

First Name 

Middle Name 

Prior Name 


Mailing Address: 

Apt: 

City: 

State: 

Zip Code: 

Country (if non-U.S.A.): 

Social Security Number: 

EMPL ID: 

Gender: 

Date of Birth: 

(If applicable) 

. 
Male 
Month /Day /Year 

. 
Female 
Telephone Number: 

Alternate Telephone Number: 

E-mail Address: 

() -


() -Are 
you a U.S. Citizen? . 
Yes . 
No 

Country of Birth ________________________ 

Country Of Citizenship ___________________ 

Immigration Status: 

*OFFICE USE ONLY* 

. 
U.S. Permanent Resident 
Date Processed 

Alien Registration (I-551) card # 

. 
Other ______________________ 
Initials 

Specify type of visa 

Please check the appropriate box: 

. 
Do you have a college degree? If yes, you must provide your college diploma. 
. 
If you have attended college(s) and have not graduated, you must provide the most recent college transcript(s). 
. 
I have included my $65.00 application fee (check or money order only) 
Note: Lehman College does not discriminate on the basis of age, sex, race, color, creed, national origin, physical or mental 

disability, sexual orientation, marital status, alienage or citizenship status, or veteran’s status. 

The college reserves the right to deny admission to any student if in its judgment, the presence of that student on campus poses 
an undue risk to the safety or security of the college or the college community. That judgment will be based on an 
individualized determination taking into account any information the college has about a student's criminal record and the 
particular circumstances of the college, including the presence of a child care center, a public school or public school students 
on the campus. 

(Over) 


Updated 11.09.2015 


Proof of immigrant or naturalized citizenship status must be shown in the Undergraduate Admissions Office, Shuster Hall, 
Room 161, when submitting this application. Copies of official documents are not accepted. 

Important Note for All Students: To be eligible for New York State resident tuition rates, you must prove that you have 
been a New York State resident and that you are either a U.S. citizen or permanent resident or that you possess an eligible 
non-immigrant status. The information requested will be used to determine if you qualify for the New York State resident 
rate. A failure to answer these questions will require you to complete the City University Residency Form. 

Where were you and each of your parents born? 
Check one in each column. 

Born in the United States, excluding Puerto Rico or 

U.S. Territories 
Born in Puerto Rico or U.S. Territories 

Born outside of the United States 

Self 

Mother 


Father 

. 


. 


. 


. 


. 


. 


. 


. 


. 


Country with which you most identify: _________________________________ 
Is a language other than English spoken at home? . 
Yes . 
No 
With which language are you most comfortable? __________________________ 
Have you been a New York State resident for the past 12 months? . 
Yes . 
No 
If yes, please give the month and year New York State residency began: ______________________________ 
Did you file a New York City/State resident income tax return during the past twelve months? . 
Yes . 
No 
Did you file a federal income tax return during the past twelve months? . 
Yes . 
No 

List below all your addresses during the past five years, starting from your current address and working 
backwards: (Attach a separate sheet of paper if necessary). 

FROM TO COMPLETE ADDRESS: 
_______ --________ ________ --_________ ________________________________________________ 
Month Year Month Year 
City State Zip Code 
______--_______ _______ --_______ ________________________________________________ 
Month Year Month Year 
City State Zip Code 
_______ --________ ________ --_________ ________________________________________________ 
Month Year Month Year 
City State Zip Code 

I certify that the information I have given on this application is accurate and complete and will be treated confidentially for 
institutional purposes only. I understand that the $65 application fee is non-refundable. 
I understand that non-matriculated (non-degree) students, including non-CUNY visiting students, are not eligible for financial aid at 

Lehman College. 
Date: __________________________ Signature: _____________________________________ 


Updated 11.09.2015