Continuing Education Student ID Request

Sussex County Community College / Non-Credit Courses ONLY
One College Hill
Newton NJ 07860
Last Name:     First Name:     M.I.:
Title:   Marital Status:   Maiden Name:  (if applicable)
Street Address/PO Box:
            Address 2nd Line:
City:     State:     Zip:     Country:
Township of Residence:     County:
Phones (xxx-xxx-xxxx)   Home:     Cell:     Other:
Social Security # (xxx-xx-xxxx):     Date of Birth (mm/dd/yyyy):
Email Address:
Parents Email Address:

This optional information is being requested solely for reporting purposes to federal and state agencies and academic accrediting associations.
Do you consider yourself to be Hispanic/Latino?    
Please select one or more of the following racial categories to describe yourself
(mark ALL that apply):

Gender (optional):    
Have you ever been convicted of a felony?    
Have you attended SCCC before?        If YES, enter your SCCC ID:

If applicant is under 18 years of age, enter Parent/Guardian's Name.
Last Name:     First Name:     M.I.:
By clicking the Submit button below, I (and my Parent/Guardian if I am under 18 years of age) certify to the best of my/our knowledge that the information on this form is correct and I/we understand that falsification may result in dismissal from the College.

If you have additional questions, please call Continuing Education at 973-300-2132 or email

Sussex County Community College's policies prohibit discrimination on the basis of sex, race, national origin (Title IX), or handicap (section 504) in its educational programs, activites, or employment and admissions practices. Inquiries regarding Title IX and section 504 compliance may be directed to the Affirmative Action Officer at 973-300-2100 or by mail at Sussex County Community College, One College Hill Road, Newton NJ 07860.