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 TO DEGREE STATUS 
Semester Applying For: . 
Fall 20____ . 
Spring 20 ____ 


Last Name First Name Middle Name Prior Name 
Mailing Address: Apt: 
Country (if non-U.S.A.):

City: State: Zip Code: 
Social Security Number: Empl ID: Gender: 
--
. 
Male . 
Female 

Month 

Daytime Telephone Number: 

Evening Telephone Number: 

E-mail Address: 

() -


() 

Are you a U.S. Citizen? . 
Yes . 
No 
Country of Birth ________________________ 

Country Of Citizenship __________________ 

Immigration Status: 

. 
U.S. Permanent Resident 
Alien Registration (I-551) card # 
. 
Other ______________________ 
Specify type of visa 
Date of Birth: 

/Day /Year 

*OFFICE USE ONLY* 

Date Processed 

Initials 

High School _______________________________ City ___________ State_____ Grad. Date_______ .Diploma .GED 

List all Colleges/Universities attended: 

________________________________________ _________-_________ _____________ ______________ 
Institution From To Degree Type Date Earned 

_______________________________________ _________-_________ _____________ ______________ 
Institution From To Degree Type Date Earned 

Intended Major _____________________________ 

Have you ever received financial aid? . 
No . 
Yes If yes, where? ______________________________ 

To Apply: 

. 
All official High School and previous college transcripts must be received before your application 

for degree status can be evaluated. 

. 
All degree students must pass the CUNY skills tests. 

. 
If not in continuous attendance, a $20 non-refundable fee will be required. 

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. 

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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 

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 application fee is non-refundable. 

Date: __________________________ Signature: _____________________________________