Fillable Printable Non-Degree Application Enrollment Application - Florida Atlantic University
Fillable Printable Non-Degree Application Enrollment Application - Florida Atlantic University
Non-Degree Application Enrollment Application - Florida Atlantic University
OFFICE OF THE REGISTRAR
777 Glades Road
P.O. Box 3091
Boca Raton, Florida 33431-0991
Telephone: 561.297.3050
954.236.1010
e-mail: [email protected]
Non-Degree Application Fee
(Non-Refundable and Non-Transferable)
An application fee of $30 must
accompany the Non-Degree Application
(check or money order)
NON-DEGREE ENROLLMENT APPLICATION
Social Security Number:________________________________________________ Semester/Year: ____________________________________
High School Graduate? Yes ¨ No ¨ A minimum of a high school diploma is required; list it below.
________________________________________________________________________________________________________________________
High School’s Name State Dates attended
FAU Graduate? Yes ¨ No ¨ If yes, what year did you graduate? __________________
List institutions attended prior to FAU: (This information must be provided for registration in graduate level courses).
________________________________________________________________________________________________________________________
Institution’s Name State Dates attended Degree Awarded
________________________________________________________________________________________________________________________
Institution’s Name State Dates attended Degree Awarded
________________________________________________________________________________________________________________________
Institution’s Name State Dates attended Degree Awarded
Name: _________________________________________________________________________________________________________________
Last First Middle/Maiden
Address: _______________________________________________________________________________________________________________
Street and Number City State Zip County
Phone: _________________________________________________________________________________________________________________
Home (include area code) Work (include area code)
Date of Birth: _________________ Gender: __________ E-mail Address: _________________________________________________________
month/day/year
In case of emergency, indicate the person you request the school to contact.
Name: _________________________________________________________________________________________________________________
Last First Relationship Home Phone
Is their mailing address the same as yours? Yes ¨ No ¨
Address: _______________________________________________________________________________________________________________
Street and Number City State Zip Country
Nation of Citizenship: ______________________________________
Non U.S. Citizens only: Resident Alien #: _____________________ Other Visa Type: ______________________________
Issue Date: ____________________________________ Date Visa/Alien Card Expires: ______________________________
(COPY OF RESIDENT ALIEN CARD OR VISA TYPE MUST BE SUBMITTED WITH YOUR APPLICATION:
MUST BE VALID THROUGH TERM OF ENTRY)
The ethnicity and race questions have been modified as required by the Federal Office of Management and Budget in the Federal Register
Notice October, 1997.
Please answer both questions.
What is your Ethnicity?
¨ Hispanic or Latino ¨ Non-Hispanic or Latino
What is your race? Please check one or more that apply.
¨ White or Caucasian ¨ Black or African American ¨ Asian
¨ American Indian or Alaskan Native ¨ Hawaiian or Pacific Islander
I am in good standing at the last institution attended (eligible to enroll). Yes ¨ No ¨
If "No," you are not eligible to attend FAU.
If your answer to either of the following is "yes," you must submit a full explanatory statement on a separate sheet attached to
this form. The University will undertake to expeditiously review your request for enrollment; however, you may not register until the
review is complete. False or incomplete responses will result in a disciplinary action, cancellation of registration or invalidation of credits
earned. If any box is checked "YES," additional documentation and/or further consideration by the Admissions Review Board may
be required.
• Have you been found guilty by any school authorities or by any court to have disrupted or interfered with orderly conduct, processes,
functions or programs by any educational institution? Yes ¨ No ¨
• Have you been charged with a violation of the law, misdemeanor and/or felony (even if adjudication was withheld) which resulted
in, or, if still pending could result in, probation, community service, restitution, a jail sentence or the revocation or suspension of your
driver’s license (you are not required to include traffic violations which only resulted in a fine)? Yes ¨ No ¨
• I certify that the above information is correct and complete and understand that falsifying or withholding information may result
in disciplinary action and withdrawal from the University. I agree to abide by the policies of the Florida Board of Education and the
rules and regulations of this University.
SOCIAL SECURITY NUMBER COLLECTION AND USAGE
________________________________________________________________________________________________________________________
FAU’s Policy on the collection and usage of Social Security Number is available at:
http://www.fau.edu/hr/files/SSN_Usage.pdf
Applicant’s Signature_____________________________________________________________ Date __________________________________
120149
