IMPORTANT: COMPLETE THE ITEMS LISTED BELOW. PLEASE PRINT OR TYPE.
---------------------1. |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|------|__|__|__|__|----- |__|__|__| -
|__|__| - |__|__|__|__|
------------------------Last Name ----------------------------------------------------------------Jr., III, IV-----__ - -Social
Security Number
----------------------- |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|-----------If you
do not have a U.S. Social Security Number, contact
------------------------First Name-------------------------------------------------------------------
---the nearest U.S. Social Security Office
and obtain one
----------------------- |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|- ---------prior
to filing this application. This will be your official
----------------------- Middle or Maiden Name-------------------------------------------------
---student number. (Foreign students leave
blank unless
-----------------------
----------------------- -----------------------
----------------------- ------- ----- you
have a U.S. Social Security Number.)
OFFICE ---------2. For which term, in what year, do you desire
admission?
USE -----------------__
FALL (August) 19 |__|__| -----__ SPRING (January) 19 |__|__| ----__ SUMMER
(May) 19|__|__|
ONLY --------------_______________________________________________________________________________________________________
|__|__| -----------3. Specify degree sought:
-----------------------------__ Master's -----__ Doctoral
-----------------------________________________________________________________________________________________________________
--------------------- 4. Nation of
Citizenship ______________________________________________ --------- 5. Sex:
__ Male ----__ Female
--------------------- _________________________________________________________________________________________________________
W
--B-- H -------6. Ethnic Origin (Required by U.S. Dept. of H.E.W. under
Title VI of the Civil Rights Act) Check One: --|
A --
-I ---------------------__ Caucasian (not Hispanic origin)--------__ African American (not Hispanic origin) ----__ Hispanic .-|
---------------- ----- --
-----__ Asian / Pacific Islander ------__---------___ American Indian / Native Alaskan ---- --------------------- --|-
77. Age ________
------------------------_______________________________________________________________________________________________________
--------------------8. Date of Birth |__|__| |__|__| |__|__|---Native
Language__________--- 9. Please indicate your religious
preference if you wish to
------------------------------------------- Mo.---- Day ----Year ------------------
------ -------- -----------_---have the appropriate campus organization advised of
---------------------------------------------------------------------------------------------------------------
-----------your presence:
_________________________
-----------------------Nation of Birth _____________________________________
-----------------------________________________________________________________________________________________________________
|__|__|__| ----10. Print your permanent
address. All correspondence will be mailed to this address.
|__|__|----------_______________________________________________________
--________________
-------------_---Number & Street -------------------------------------------------------------_________----City
----------------__________
--------____________--------____________---------------------------------------------______-______-___________
----------------_----County----------------State
or Nation --------Zip Code -------------------------------------------------Area Code ---Number
------------------------_______________________________________________________________________________________________________
--------------------11. Emergency -------_____________________________________________________________________________________
-------------------------Addressee ----_---Last Name ------- ------- ------- ------- ---First ------- ------- ------- - ------- --Middle or Maiden
------- --------- -------List relationship: __ Mother __ Father __ Spouse __
Legal Guardian __ Other (Specify) ___________________________
_______________Address (if
different from address in number 10 above)
-------- --------- ----_______________________________________________________
--________________
--------__--------Number & Street ------------------------------------------------------------------_____----City
|__|__|-----------__________ --------____________--------____________---------------------------------------------______-______-___________
------------------------County----------------State
or Nation --------Zip Code______________________________Area Code ---Number
|__|__|__| -------___________________________________________________________________________________________________________
--------------------12. In which academic division do you wish to enroll?
(e.g. School of Hospitality Management, etc.)
___________________________
|__|__|-----------What is your planned major?
_________________________________________________
|__|_-------------___________________________________________________________________________________________________________
--------------------13. If there is a possibility that any credentials
(transcripts, test scores, etc.) might arrive under a name
different from that given
_______________in Item 1, please provide
name(s) here:
_________________________________________________________________
| List below in chronological order every college, university, trade or technical school you have ever attended (or plan to attend) prior to enrolling at this university. Use an additional sheet, if needed. Have all transcripts sent to the FIU Admissions Office. | Indicate below dates of attendance (including present enrollment) and degrees earned (or that you anticipate earning). | ||||||||||||||||
| Dates of Attendance | -----List all Degrees with Dates | ||||||||||||||||
| --From | - To | -----Earned | ------Expected | ||||||||||||||
| ----------------------------Name of School | ------Location | -Mo | -Yr | Mo | -Yr | -Degree | -Mo | -Yr | -Degree | -Mo | -Yr | ||||||
| ___|___ | _ | | _| | _| | _| | _ | | _ | | _ | | _ | | |||||||||
| ___|___ | _ | | _| | _| | _| | _ | | _ | | _ | | _ | | |||||||||
| ___|___ | _ | | _| | _| | _| | _ | | _ | | _ | | _ | | |||||||||
| ___|___ | _ | | _| | _| | _| | _ | | _ | | _ | | _ | | |||||||||
WK:
RES:
HSC:
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