Application For Admission Form
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1
2Learning for a Lifetime
Application for Admission
The UNF Learning for a Lifetime Program is a non-degree program offered to Florida residents aged 60 or older. Courses are taken on an
audit basis. Proof of Florida Residency is required in order to gain admission. Admitted students are eligible for a tuition waiver. The
tuition waiver does not waive late registration, re-registration, or miscellaneous fees.
Section I
Applicant Name: __________________________________________ Address_______________________________________________
Social Security #: __________________________________________ City __________________________________________________
Date of Birth ___________/____________/_____________
State_________________ Zip__________________
Email address_____________________________________
Phone (________) ____________ - ______________
Nation of Citizenship: ______________________________
Gender:
Male
Female
Race/National Origin: (voluntary):
White
Black or African American
Hispanic or Latino
Asian
Native Hawaiian or other Pacific Islander
American Indian or Native Alaskan
Other:_______________________________________________________________
High School Graduation Date: ________/_________
Have you ever attended College?
Yes
No
month
year
If yes, where did you attend?____________________________________
Highest Degree earned?________________________________________
For which term do you seek admission?
Fall Term ___________
Spring Term __________
Summer Term ___________
year
year
year
Failure to answer the following questions will result in a delay in processing your application. If your answer to either of these questions is
“Yes,” you are required to provide a written explanation of the event. You may be required to furnish UNF with statements from your school
administration or legal representation and copies of all official documentation explaining the final disposition of the proceedings. If your
records have been expunged pursuant to applicable law, you are not required to answer “yes” to these questions.
Are you currently or have you ever been charged with or subject to disciplinary action for misconduct at a post-secondary institution?
Yes
No
Have you ever been convicted and/or have charges pending of any criminal offense other than a minor traffic violation?
Yes
No
I understand and agree that I will be bound by the University’s regulations concerning application deadline dates and admission
requirements. I further agree to release any transcripts, student records, and test scores to UNF. I certify that the information given in this
application is complete and accurate, and I understand that to make false or fraudulent statements within this application may result in
disciplinary action, denial of admission, and invalidation of credits or degrees earned. If admitted, I hereby agree to abide by the policies,
rules, and regulations of the University. Should any of the information I have given change prior to my entry to the University, I will
immediately notify the Office of Admissions.
Section II
___________________________________________________________________
______________________________
Student Signature
Date
Continue on to next page
Received by: ________
Processed by: _________
Date:______________
Updated 1/20/2012
Date: _______________
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