ApplicationFeePaymentForm
StudentsMUSTsubmitthe$55non-refundableapplicationfeewhenapplyingforadmission.Inordertoproperlyapplythepaymentto
thestudent’saccount,pleaseattachacheckormoneyorderandmailto:
NassauCommunityCollege
OfficeoftheBursar,SSC,TowerLL
OneEducationDrive
GardenCity,NY11530
Student’sName:______________________________________________
LastFourDigitsofSocialSecurityNumber***/**/______________
StudentDateofBirth____/____/_______
Studentsignature:_____________________________________________Date____/_____/______
Paymentby: Check
Attachchecktothisform

MoneyOrderA
Attachmoneyordertothisform
*Amountofpayment$_______*NOTE:the$55fee,accompaniedbythisApplicationFeeForm,
mustbepaidbeforeyourapplication
can be processed. Thank you!
ApplicationFeePaymentForm
StudentsMUSTsubmitthe$55non-refundableapplicationfeewhenapplyingforadmission.Inordertoproperlyapplythepaymentto
thestudent’saccount,pleaseattachacheckormoneyorderandmailto:
NassauCommunityCollege
OfficeoftheBursar,SSC,TowerLL
OneEducationDrive
GardenCity,NY11530
Student’sName:______________________________________________
LastFourDigitsofSocialSecurityNumber***/**/______________
StudentDateofBirth____/____/_______
Studentsignature:_____________________________________________Date____/_____/______
Paymentby: Check
Attachchecktothisform

Money Order A
Attach money order to this form
*Amountofpayment$_______*NOTE:the$55fee,accompaniedbythisApplicationFeeForm,mustbepaidbeforeyourapplication
canbeprocessed.Thankyou!