* = required field

Personal Information


An affirmative response to the above questions will not automatically prevent enrollment, but you may be asked to provide additional information. This information will be reviewed to ensure safety. Any falsification or omission of data may result in a denial of enrollment and/or dismissal.


Student Registration Information

Education History

College Information

List all colleges you have attended

Optional - This is used for statistical reports only

I wish to enroll in the following classes at Siena College for the term listed at the top of the form:

I also understand that if I enroll in more than 11 credits, Full-Time Tuition Rates will apply. See Siena College Catalog on-line at www.siena.edu/academics. I also acknowledge that it is my full responsibility to inform Siena College if I no longer wish to take these classes. Failure to notify Siena will result in me being responsible for paying all of, or part of the tuition fee for these classes, as set forth by Siena College’s Business Affairs Office as pertaining to policies and procedures.

Course 1

Course 2

Course 3

Certification & Signature

By submitting this form on-line, I certify that the information I have given is complete and true to the best of my knowledge and that I shall comply with all the rules and regulations of the College which may be in effect or which shall become effective while I am a student, including those outlined in Siena Life. I understand that I must comply with New York State immunization health law and that failure to comply with the law may result in disenrollment from the college without refund of tuition and fees. I understand that Siena College reserves the right to ask for further information regarding my current and former educational records and to revoke my registration for prior unsatisfactory academic performance or conduct determined to be unacceptable for continued registration at the College. I also understand that the College may exclude, at any time, students who do not meet minimum academic standards in their registered courses or who engage in conduct in violation of the Student Code of Conduct or other policies set forth in Siena Life. I agree that if I engage in any recreational or athletic activities, I assume the risk involved in any such activities, and I hereby agree that the College will have no liability therefore. I acknowledge that Siena College has the right to deny registration based on the information listed on the form.