Transient Student Form - State University System Of Florida

TRANSIENT STUDENT FORM – State University System of Florida

This form enables you to transfer credits of pre-approved courses within the State University System (listed below) for ONE TERM only.

RECEIVING

Florida International University

PARENT SCHOOL:

Florida A & M University, Tallahassee, FL 32307

Instructions:

1)

Enter on the line above the name of the parent school (where you

Florida Atlantic University, Boca Raton, FL 33431-0991

are earning your degree). Check to the right the SUS school, known

Florida Gulf Coast University, Fort Myers, FL 33908-4500

as the receiving school, you will be attending as a transient student,

then complete and sign Section A.

Florida State University, Tallahassee, FL 32306-1011

2)

Ask your academic Advisor to complete and sign Section B. The

University of Central Florida, Orlando, FL 32816-0114

gold copy of this form may then be kept by your advisor for

departmental use.

University of Florida, Gainesville, FL 32611

3)

The Office of the Registrar of your parent school must complete

University of North Florida, Jacksonville, FL 32216

Section C. You are then responsible for mailing or hand delivering

the white copy to the OFFICE OF THE REGISTRAR of the receiving

University of South Florida, Tampa, FL 33620-6900

school. (Address listed to the right.)

4)

Make sure you keep a copy for yourself.

New College, Sarasota, FL 33580

University of West Florida, Pensacola, FL 32514-5750

Completion of this form does not constitute Registration.

SECTION A: To be completed by student applicant.

Do not leave any questions blank.

Please print with ballpoint pen.

1.

Social Security Number

2. Last Name

______

First Name

__

MI ___

Student ID

Birth Date

Fall

Spring

6. Race:

___________________________

5. Sex

3. Term/Year

Nation of

4. ___ / ___ / ___

Summer

Male

Female

Citizenship ___________________________

Mo. Day Yr.

7. Permanent _________________________________________________________________________________________________________________

Address

Number and Street Address

___________________________________

___________

_________________ - _____________

(____)

_______________

City

State

Zip Code

Area Code

Telephone Number

8. Address During

________________________________________________________________________________________________________

term of attendance

Number and Street Address

as a transient

__________________________

___________

_________________ - _____________

(____)

_______________

student.

City

State

Zip Code

Area Code

Telephone Number

9. Highest degree held at time of transient registration.

None

Associate

Bachelor

Master

Other

__________________________________________________________

I understand that if I register for courses not approved herein, I assume the full risk of transferability. I also understand that this application is for the ONE TERM specified and that a

new form with approved courses must be submitted in order to continue my transient status within the State University System of Florida. I also understand that I must provide the

parent school with an official transcript from the receiving school and I authorize the release of such records accordingly.

Signature of Student ___________________________________________________________________________ Date: ________________________

SECTION B: To be completed by academic Advisor. Please print with a ballpoint pen.

COURSE APPROVAL: The above-named student is hereby authorized to take the following course(s) during the one term specified. Transfer credit for these

courses will be acceptable upon the receipt of an official transcript according to the regulations of the parent school.

Prefix (Subject Area)

Course (Catalog Number)

Hours

Course Title

Parent School Equivalent

1. ______________________

_________________________

_______

_____________________________

______________________________

2. ______________________

_________________________

_______

_____________________________

______________________________

3. ______________________

_________________________

_______

_____________________________

______________________________

4. ______________________

_________________________

_______

_____________________________

______________________________

___________________________________________________________

____________________________________________________________

Signature of Academic Advisor

Date

Signature of Academic Dean

Date

___________________________________________________________

____________________________________________________________

Signature of International Student Office if Applicable

Date

Signature of Sponsoring Dean

Date

SECTION C: To be completed by the Registrar’s Office of the parent school.

Yes NO

1. The above-named student is regularly enrolled in a degree program and is eligible to re-enroll.

2. This student has a student health form on file indicating she/he has the required Measles and Rubella immunizations.

3. This student has completed the CLAST requirement.

4. This student has the required documentation on file w ith the parent school to meet the legal classification

Parent School Validation

Florida Resident

Non-Florida Resident

Non-Florida Resident Alien

Non-Resident Alien

Florida Resident Alien

Authorized Signature: _________________________________________________ Date: _______________________

Distribution:

1) White-Registrar of Receiving School

2) Yellow-Student Copy

3) Pink-Registrar of Parent School

4) Gold Academic Advisor/Department Copy