| Note: Required fields are denoted by an
*. |
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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: |
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Nation of citizenship *
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Citizenship Code: *
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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.) |
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Primary
language:* |
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Permanent mailing address: |
| Street: * |
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| City: * |
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| County: * |
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| State: * |
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| Zip code: * |
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| State or
province (non-U.S.): |
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| Nation:* |
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| Email address:* |
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Area Code |
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| Evening phone:* |
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| Daytime phone: |
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| Fax: |
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Local mailing address |
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| Street: |
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| City: |
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| County: |
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| State: |
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| Zip code: |
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| State or
province (non-U.S.): |
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| Nation:
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Area Code |
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| Evening phone: |
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| Daytime phone: |
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| Fax: |
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In case of emergency, indicate the
person you request the school to
contact. |
| Last name:* |
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| First name:* |
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| Middle: |
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Area Code |
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Evening phone:* |
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Daytime phone: |
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Fax: |
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| Relationship:* |
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| Street:* |
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| City:* |
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| County: * |
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| State: * |
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| Zip code:* |
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| State or
province (non-U.S.): |
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| Nation:* |
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Occupational or Professional
Experience After Graduation From
College:
Indicate how you spent or how you
plan to spend all the time from
graduation until the beginning of
the anticipated term of enrollment.
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An
official transcript from
each post-secondary school,
college, or university you
have attended must be
provided.
- List first the
institution from which
you received your
highest degree.
- Include the
institution to which you
are applying if you
attended it previously.
- For multi-campus
institutions, indicate
the specific campus.
- For dates of
attendance (including
present enrollment),
enter dates attended and
degrees earned or
expected before
attending the
institution to which you
are applying. Include
Associate Degrees,
certificates, or
diplomas.
- Failure to list
all institutions could
result in your
application being denied
or your admission being
rescinded.
- Please do not
abbreviate.
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| Degree: |
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| Degree: |
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| Degree: |
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| Degree: |
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If you have taken or
plan to take any of
the following tests,
enter the month and
year. Official
records of all test
scores must be
provided. |
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Failure to
answer both
questions
will delay
processing
of your
application. |
| If your
answer to
either of
the
following is
yes, you
must provide
a full
explanation.
In the text
area below,
state the
circumstances
of the
disciplinary
problems.
Please be
concise. You
are limited
to 210
characters.
If you
exceed this
limit you
will be
asked to
edit your
response
down to 210
characters.
This
information
will not
necessarily
exclude you
for
admission,
will be
handled
confidentially
and will
permit
counseling
assistance
to be
offered by
the
institution. |
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| If
your records
have been
expunged
pursuant to
applicable
law, you are
not required
to answer
yes to these
questions.
If you are
unsure
whether you
should
answer yes
to either
question, we
strongly
suggest that
you answer
yes and
fully
disclose all
incidents.
By doing so,
you can
avoid any
risk of
disciplinary
action or
revocation
of an offer
of
admission. |
If
you
are
not
claiming
Florida
residency
for
tuition
purposes,
click
the
button
in
the
"Non-Florida
Residents"
section
near
the
top
of
the
page.
If
you
are
claiming
Florida
residency,
fill
out
the
fields
on
this
page
and
click
the
button
at
the
bottom
of
the
page.
If
pages
exceed
the
width
of
your
browser,
you
may
find
it
useful
to
temporarily
reduce
the
size
of
your
fonts.
In
Netscape,
press
ctrl
[
to
reduce
font
size
and
ctrl
]
to
increase.
Internet
Explorer
users
should
click
on
View->Text
Size
and
select
the
appropriate
choice.
If
you
use
another
browser
or
if
you
need
more
information,
consult
your
browser's
documentation.
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Information
for
Residency
Classification
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Florida Residents
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| This section must be completed in full if you claim Florida residency for tuition purposes. |
- Please mail required copies to the admissions office of the institution to which you are applying.
- A copy of your and/or your parents' most recent tax return or other documentation may be requested to establish dependence/independence.
- Dependent: a person for whom 50% or more of his/her support is provided by another as defined by the Internal Revenue Service.
- Independent: a person who provided more than 50% of his/her own support.
- A copy of the marriage certificate is required in all cases of spouse claiming partner's residency.
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A. I am an independent person and have maintained legal residence in Florida for at least 12 months. |
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B.I am a dependent person and my parent or legal guardian has maintained legal residence in Florida for at least 12 months. |
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C. I am a dependent person who has resided for five years with an adult relative other than my parent or legal guardian, and my relative has maintained legal residence in Florida for at least 12 months. (Required: Copy of most recent tax return on which you were claimed as a dependent, or other proof of dependency.) |
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D. I am married to a person who has maintained legal residence in Florida for at least 12 months. I have now established legal residence and intend to make Florida my permanent home. (Required: Copy of marriage certificate, claimant's voter registration, driver license and vehicle registration.) |
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E. I was previously enrolled at a Florida state institution and classified as a Florida resident for tuition purposes. I abandoned my Florida domicile less than 12 months ago and am now re-establishing Florida legal residence. |
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F. According to U.S. Citizenship and Immigration Services, I am a permanent resident alien or other legal alien granted indefinite stay and have maintained a domicile in Florida for at least 12 months.(Required: USCIS documentation and proof of Florida residency status.) |
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G. I am a member of the Armed Services of the United States and I am stationed in Florida on active military duty pursuant to military orders, or whose home of record is Florida, or I am a member's spouse or dependent child. (Required: Copy of military orders or DD2058 showing home of record.) |
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H. I am a full-time instructional or administrative employee employed by a Florida public school, community college or institution of higher education, or I am the employee's spouse or dependent child. (Required: Copy of employment verification.) |
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I. I am part of the Latin American/Caribbean Scholarship Program. (Required: Copy of scholarship papers.) |
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J. I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s. 1009.988, F.S.) (Required: copy of Florida pre-paid recipient card.) |
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K. I am living on the Isthmus of Panama and have completed 12 consecutive months of college work at the F.S.U. Panama Canal Branch, or I am the student's spouse or dependent child. (Required: Copy of marriage certificate or proof of dependency.) |
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L. I am a Southern Regional Education Board's Academic Common Market graduate student. (Required: Certification letter from State Coordinator.) |
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M. I am a full-time employee of a state agency or political subdivision of the state whose student fees are paid by the state agency or political subdivision for the purpose of job-related law enforcement or corrections training. |
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N. I am a McKnight Fellowship recipient. (Required: Verification from graduate studies.) |
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O. I am an active member of the Florida National Guard who qualifies under s.250.10 (7) and (8) for the tuition assistance program. |
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P. I am an active duty member (or the spouse/dependent child of the member) of the Armed Services of the United States attending a public community college or university within 50 miles of the military establishment where the member is stationed, if such military establishment is within a county contiguous to Florida. |
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Q. I am an active duty member (or the spouse or dependent child of the member) of the Canadian military residing or stationed in this state under the North American Air Defense (NORAD) agreement, attending a public community college or university within 50 miles of the military establishment where the active duty member is stationed. |
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R. I am a U.S. Citizen living outside the U.S. who is teaching at a Department of Defense Dependent School or in an American International School and who has enrolled in a graduate level education program which leads to a Florida teaching certificate. |
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S. I am an active duty member (or spouse/dependent child of the member) of a foreign nation's military who is serving as a liaison officer. I am residing or stationed in Florida and attending a community college or state university within 50 miles of the military establishment where I am stationed.
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Person claiming residency must complete this section in full. |
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- Documents supporting the establishment of legal residence must be dated, issued, or filed 12 months before the start of the term. All documentation is subject to verification.
- Additional documentation may be requested.
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I do hereby swear or affirm that the above named student meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06, Florida Statutes.
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