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First name: * Middle name: Last name: * Jr., III, etc.
 
Date of Birth:*       Month:                Day:   
          		              Year: 
               		 
       
             
               
City of Birth: (Do not include state or country) *
 
Mother's Maiden Name: (Last name only) *

 
Nation of citizenship *
Citizenship Code: *
For which term, in which year, do you seek admission? * *Year:
Select the FAU campus you wish to attend:
(less than 60 hours must attend the Boca Raton Campus,
except for the Honors College)
This application is for enrollment as: *
   
Please select the option which reflects how many semester hours of college credit you will have at the time you enter this institution:*  
 
Major: *
Specialization within major:  
Is your enrollment dependent upon receipt of an assistantship or fellowship?* Yes No
Would you like to request special admission consideration based upon a disability? Yes No
Are you currently enrolled at this institution? * Yes No
Will you attend full time or part time?* Full Time Part Time
 
College of Education Applicants ONLY (If you are not sure please contact your prospective graduate program.)
Do you require Certification? Yes No    
If you have previously submitted an application to this institution, please enter the month and year of the term that you applied for.
Year:
 
If you have previously attended this institution, please indicate the date that you started and the last date you attended.
From: Year:
To: Year:
 
Names of your immediate family members who have attended this university.
First Name Middle Name Last name Relationship
 
 
Note: Required fields are denoted by an *.  
U.S. Social Security Number (without dashes): *
If you do not have a SSN, please enter all 0's.
   
 
If your transcripts, test scores, etc. might arrive under any name(s) other than those listed above, enter here:
 
  First:
 Middle:
 Last:
 
 
   
Nation of citizenship *            
Citizenship Code: *            
Gender: *  Male Female  
 
Race/national origin. (Each SUS institution is a recipient of federal dollars and is required by the federal government to solicit certain demographic information to meet federal reporting requirements. Applicants are requested to provide race/national origin information voluntarily. This information will not be used in a discriminatory manner.)
   
Primary language:*  
Are you an active duty service member? Yes No
 
Are you a veteran of the U.S. Military? Yes No  
 
Permanent mailing address:
Street: *
.
City: *
County: *
State: *
Zip code: *
State or province (non-U.S.):
Nation:*
Email address:*  
  Area Code    
Evening phone:*
-
Daytime phone:
-
Fax:
-
 
Local mailing address
 
Street:
.
City:
County:
State:
Zip code:
State or province (non-U.S.):
Nation: