Fillable CHANGE IN REGISTRATION STATUS (Florida Institute of Technology)

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CHANGE IN REGISTRATION STATUS (Florida Institute of Technology)

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The CHANGE IN REGISTRATION STATUS (Florida Institute of Technology) form is 1 page long and contains:

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  • 10 check-boxes
  • 107 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Florida Institute of Technology

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Academic Unit Head/Program Chair Signature ________________________________________________________  Date ______________________________________________________
Print Name ________________________________________________________________________________________
College Dean Signature _____________________________________________________________________________  Date ______________________________________________________
Print Name ________________________________________________________________________________________
Account Management Signature _____________________________________________________________________  Date ______________________________________________________
Registrar Signature _________________________________________________________________________________  Date ______________________________________________________
1. ❏ Drop me from all my classes.  ❏ I do not plan to return.  ❏ I plan to return _______________________________________________ semester.
2. ❏ I am not currently registered—withdraw me from the university.  3. ❏ Process course(s) listed below.
SELECT ONE
CRN PREFIX COURSE NO. SEC COURSE TITLE CRS. INSTRUCTOR SELECT ONE
ADD DROP AUDIT CEU
❏  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
❏
  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
❏
  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
❏
  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
❏
  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
❏
  ❏ ________________ __________ ___________________ _________  _________________________________________________________________ _______   _______________________  ❏  ❏
ANY LINE LISTED ABOVE THAT IS CROSSED OUT MUST BE INITIALED BY ADVISOR.
MY REASON FOR REQUESTING THIS CHANGE IS _____________________________________________________________________________________________________________________
Academic Advisor/Site Representative Signature _______________________________________________________________ Date ______________________________________________
Comments ______________________________________________________________________________________________________________________________________________________
Final grades will be: ❏ No Record ❏ W ❏ NA   Tuition Credit (%) ________________________________________________________
Processed By ___________________________________Date _________________ SGASTDN: ❏ WS ❏ WR  SFAREGS: ESTS Code __________________RSTS________________
Title IV Recipient? ❏  Yes  ❏ No Financial Aid Initials/Date __________________________________ Campus Services/Housing Initials/Date _______________________________
DATE ___________________________________________________
Students are responsible for meeting all published prerequisite requirements for their registered courses to ensure they have the
background necessary for successful performance. A student who fails or drops a prerequisite course after registration for the following
term, must, in consultation with his/her advisor, submit a “Change in Registration Status” form to add the prerequisite course.
ADDITIONAL SIGNATURES MAY BE REQUIRED
ACADEMIC ADVISOR APPROVAL REQUIRED
Submit form with appropriate signatures, directly to the Registration Center/o-campus site. Do not list individual course(s) if
dropping all classes or withdrawing from the university. Please check plans to return or not. Select one option box (1, 2 or 3) below.
FOR OFFICE USE ONLY
STUDENT INFORMATION: Florida Tech Online students should scan and email the form to their representative or fax
the form to 800-576-8532. All other students may use the information at the bottom of the form or bring to the Registration Center.
MAJOR CODE
_____________________  TERM ___________________________________________________________  OFF-CAMPUS SITE _________________________________________
NAME ____________________________________________________________________________________________________ STUDENT ID NO. _______________________________________
Last First Middle
I HAVE ATTENDED ___________ WEEK(S) OF CLASSES. Student Signature/Date __________________________________________________________________________
1. I receive veterans education benets. ❏ Yes ❏ No _________________________________________________________________________________
Veterans Aairs Coordinator Signature Date
2. I am an international student. ❏ Yes ❏ No _________________________________________________________________________________
International Student and Scholar Services Signature Date
❏ Yes ❏ No _________________________________________________________________________________
3. I am a student-athlete. Athletics Coach Signature Date
_________________________________________________________________________________
Athletics Compliance Ocer Signature Date
4. This is my rst registration at Florida Tech. ❏ Yes ❏ No
Financial aid may be aected If DROPPING BELOW full-time status (12 credits for undergraduate students and 9 credits for graduate students).
ISSS signature required only If DROPPING BELOW full-time status (12 credits
for undergraduate students and 9 credits for graduate students).
Veterans are required to give a reason (see below) for dropping classes.
KEEP A COPY FOR YOUR RECORDS
20200784
Florida Institute of Technology
■
Oce of the Registrar
■
150 W. University Blvd., Melbourne, FL 32901-6975
■
321-674-8115
■
Fax 321-674-7827
CHANGE IN REGISTRATION STATUS
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CHANGE IN REGISTRATION STATUS (Florida Institute of Technology)

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Completed 29 January 2021

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