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Fairleigh Dickinson University (Fairleigh Dickinson University)

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BROWSE FAIRLEIGH DICKINSON UNIVERSITY FORMS

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Fairleigh Dickinson University
APPLICATION FOR VISITING HIGH SCHOOL STUDENTS (Juniors and Seniors Only)
High School JUNIORS and SENIORS, who have a minimum 3.0 overall grade point average, can request to take college courses for credit
or non-credit (audit) at Fairleigh Dickinson University. Tuition and fees apply.
Please complete the application and accompanying Registration Form* and submit with a $40 nonrefundable application fee (payable to
Fairleigh Dickinson University).
The application must include: 1) ALL required signatures and dates; 2) A LETTER OF RECOMMENDATION, preferably on high school
letterhead; and 3) An unofficial copy of your current transcript which will allow the University to verify your GPA along with prerequisites,
if applicable.
* To locate course schedules, go to fdu.edu/coursefinder. FDU reserves the right to cancel a scheduled class if enrollment is insufficient.
Please type or print.
I. GENERAL INFORMATION
Last Name ________________________________________________ First _________________________________ Middle Initial _________
Permanent Address ____________________________________________________________________________________________________
City ______________________________________________________ State ____________________ Zip _______________________________
Home Phone (_________) ___________________________________ School/Business Phone (_________) ___________________________
Cell Phone (_________) ____________________________________ Email ______________________________________________________
Social Security No. _____ _____ _____ _____ (Optional; last 4 digits only) Date of Birth ________________________________________
Month Day Year
Gender: b Male b Female
A. Ethnicity
(Optional; for statistical purposes only)
Are you Hispanic/Latino? b Yes b No
Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more.)
b American Indian or Alaska Native b Asian b Black or African American b Native Hawaiian or Other Pacific Islander b White
B. My preferred campus is:
b Metropolitan Campus (Teaneck, NJ) b Florham Campus (Madison, NJ) b Online
C. I plan to enter FDU:
b Fall 20_____ b Spring 20_____ b Summer 20_____
Have you ever attended Fairleigh Dickinson University? b Yes b No
If yes, please indicate campus and dates of attendance: _____________________________________________________________________
Campus From/To
II. OTHER INFORMATION
Have you ever been convicted of a felony? b Yes (Please explain using a separate sheet of paper.) b No
Have you ever been suspended, expelled or required to withdraw from any secondary or post-secondary institution?
b Yes (Please explain using a separate sheet of paper.) b No
continued
RESET
PRINT
Rev. 11.16
III. SCHOOL APPROVAL
____________________________________________________________________________________________ __________________________
Signature of Guidance Officer/Principal Title
IV. AUTOMATIC TRANSCRIPT REQUEST
Fairleigh Dickinson University will provide one (1) transcript, without charge. To request additional transcripts, go to getmytranscripts.org.
Additional fees apply.
Name of High School ___________________________________________________________________________________________________
Address _______________________________________________________________________________________________________________
City ______________________________________________________ State ____________________ Zip _______________________________
READ CAREFULLY AND SIGN
I certify that the information on this application is complete and correct and I authorize the University to verify the information provided. I agree to
notify the Admissions Office of any changes in the information provided. The University reserves the right to deny admission and matriculation to
any applicant who, in the judgment of the University, is not qualified, may not benefit from the University’s educational programs or whose presence
or conduct may impact negatively on its program(s). Students applying for admission to the University agree to abide by all the rules and regulations
now or hereafter promulgated by the University. Any student failing to comply with such rules and regulations is subject to their application being
rejected, offer of acceptance being rescinded, enrollment being cancelled or other appropriate disciplinary actions. Submission of false information,
in this application or otherwise, is deemed a violation of University rules and regulations. The signing of this application constitutes an agreement on
the part of the student that they understand, agree to be bound by, the foregoing.
________________________________________________________________________________________________________________________
Signature of Student Date
________________________________________________________________________________________________________________________
Signature of b Parent b Guardian (If Guardian, please include type of guardianship below) Date
________________________________________________________________________________________________________________________
Type of Guardianship
SEND COMPLETED APPLICATION AND REGISTRATION FORM TO:
METROPOLITAN CAMPUS
Undergraduate Adult & Part-time Admissions
1000 River Road, H-DH3-10, Teaneck, NJ 07666
Phone: 201-692-2551
Fax: 201-692-7305
Fairleigh Dickinson University is committed to providing equal opportunity to all qualified persons and does not discriminate on the basis of race, religion, creed, national
origin, sex, disability, age, sexual preference, sexual orientation, marital status, military status or veteran’s status with regard to recruitment, admission or matriculation.
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REGISTRATION FORM
b Graduate SEMESTER: b Spring b Summer YEAR: 20______
b Undergraduate (Please indicate) b Fall b Wintersession
___ ___ ___ ___ ___ ___ ___ _________________________________________________________________________
Student I.D. Number Last Name First Name Middle Initial
___________________________________________________________________________________________________________________________________________
Home Address: Street City State Zip
____________________________________ ________________________________________ _____________________________ _____________________________
Academic Program Email Address Home Phone Business/Cell Phone
REGISTRATION CONTRACT: I understand that enacting a registration creates a legal contract with the University that results in the holding of all classes. This
registration generates an indebtedness to the University that can be reduced or cancelled upon the receipt of a signed statement from the student within the time
frame outlined in the cancellation clause (see below). Registering for coursework certifies that you are fully aware of and accept the terms of this contract as
stated. Payments received after the last day of the term will be assessed a 12% late fee.
ATTENTION: THE STUDENT IS ULTIMATELY RESPONSIBLE FOR ENROLLING IN THE APPROPRIATE COURSE AND SECTION.
___________________________________ ___________________________________ ___________________________________ ____________
Student’s Signature Advisor’s Signature Additional Signature (if required) Date
To complete this form, go to fdu.edu/coursefinder to locate course schedule (note restrictions and/or prerequisites). Please type or print, sign and date. Submit
with application or fax to 201-692-7305. FDU reserves the right to cancel a class if enrollment is insufficient.
E.S. USE ONLY
Clerk Date CR
SUBJECT & CAT. NO SECT COURSE TITLE DAYS & TIME CR ALTERNATE SECTION/COMMENTS
TOTAL CREDITS
PAYMENT DEADLINE: Please adhere to payment deadlines and policies established by the University for each semester. Failure to comply will result in late charges.
CANCELLATION CLAUSE: The Effective Date of any alterations of a student’s schedule will be the official date of receipt. Only those alterations with an Effective
Date prior to the first day of classes will be accorded a 100% cancellation of charges.
COLLECTION FEE: By registering for a course or courses, the student has entered into a contractual agreement with Fairleigh Dickinson University and has a
financial obligation to pay the expenses incurred. In the event the student fails to honor his/her financial obligation, the student will also be responsible to pay all
collection costs associated with the University’s attempt to collect the due balance; collections costs can include a third party collection fee of 30% of the past due
balance. The University reserves the right to report unpaid account information to any credit bureau.
LATE PAYMENT CHARGES: A late payment charge will be collected at the time any payment (full or partial) is applied to an outstanding balance. Late payment
charge will begin at a rate of 2%. Payments after the last day of term will be assessed a 12% late fee.
CORPORATE VOUCHER: All third party corporate vouchers must be submitted at the time of registration.
FALL & SPRING SEMESTERS NINE WEEK SESSIONS SIX WEEK SESSIONS THREE WEEK SESSIONS
REFUND/CANCELLATION OF TUITION AND FEES
EFFECTIVE DATE
Prior to 1st day of
semester
During 1st week of
semester
During 2nd week of
semester
During 3rd week of
semester
During 4th week of
semester
During 5th week of
semester
After 5th week of
semester
EFFECTIVE DATE
Prior to 1st day of
semester
During 1st week of
semester
During 2nd week of
semester
During 3rd week of
semester
During 4th week of
semester
EFFECTIVE DATE
Prior to 1st day of
semester
During 1st week of
semester
During 2nd week of
semester
During 3rd week of
semester
EFFECTIVE DATE
Prior to and during
the 1st and 2nd days
of session
During the 3rd day
of session to end of
session
CANCELLATION
OR REFUND
100% cancellation of
tuition and course
fees
90% cancellation of
tuition charges only
80% cancellation of
tuition charges only
60% cancellation of
tuition charges only
40% cancellation of
tuition charges only
20% cancellation of
tuition charges only
NO CANCELLATION
OF TUITION OR FEES
CANCELLATION
OR REFUND
100% cancellation of
tuition and course
fees
70% cancellation of
tuition charges only
50% cancellation of
tuition charges only
30% cancellation of
tuition charges only
NO CANCELLATION
OF TUITION OR FEES
CANCELLATION
OR REFUND
100% cancellation of
tuition and course
fees
75% cancellation of
tuition charges only
50% cancellation of
tuition charges only
NO CANCELLATION
OF TUITION OR FEES
CANCELLATION
OR REFUND
100% cancellation of
tuition and course
fees
NO CANCELLATION
OF TUITION OR FEES
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Completed 21 August 2020

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