Your Passport to Success

I am a ______ completing this form:

Parent Information

Relationship to Student:

First Name

Last Name

Student Personal Information

First Name

Last Name

Preferred Name

Birthdate

Primary Citizenship

Are you a U.S. Permanent Resident?

Yes

What are your pronouns? Check one or more options.

He/Him/His

She/Her/Hers

They/Them/Theirs

Other

Please add other pronouns in the text box below.

Student Contact Information

Email Address

Mobile Phone

Mailing Address

Country

Street

City

Region

Postal Code

Pioneer Passport is a program for New York State First-Year students. Please fill out our Inquiry Form here.

Student Academic Information

Intended Level of Study

Student Type

Pioneer Passport is a program for New York State First-Year students. Please fill out our Inquiry Form here.

I am interested in studying:

Plan to attend Utica in:

High School
(If you cannot locate your school in the dropdown, please type the name, city and state of the school.)

Contact Us

Cynkus Family Welcome Center

(315) 792-3006

Clark City Center

(315) 792-3053