Back to the College of Staten Island Home Page

Clearinghouse Enrollment Audit Form
Complete this form to address an enrollment reporting issue.
We will investigate the matter and contact you via email you provided.

*Indicates required field

Applicant Information

Last Name*


First Name*
Middle Name

Date of Birth*
- - (MM-DD-YYYY)

Have you ever had your name changed? *

Yes        No

If you had your name changed, what was your former name?
First Name*

Last Name*

Email*

What was your last semester of attendance at the College of Staten Island? *

Semester ... Winter Spring Summer Fall   Year

Number of credits you were registered for *


What issue are you having? *