Fairleigh Dickinson University
AUDIT FORM • Undergraduate Adult & Part-Time Admissions
Complete this AUDIT FORM after being admitted to the University. Go to fdu.edu/achieve for Audit requirements. Tuition and fees apply.
Please type or print.
FDU Student ID# _______________________________________________________________________________________________________
b Senior Citizen Program ________________________________________________ Date __________________________________________
b Adult Program ________________________________________________________ Admissions ____________________________________
b Alumnus _____________________________________________________________
b Other ________________________________________________________________
I. GENERAL INFORMATION (Please print)
Name _________________________________________________________________________________________________________________
Street Address _________________________________________________________________________________________________________
City ______________________________________________________ State ____________________ Zip _______________________________
Phone ____________________________________________________ Date of Birth ________________________________________________
Month Day Year
Email _________________________________________________________________________________________________________________
II. COURSE INFORMATION
IMPORTANT: NO REGISTRATIONS WILL BE ACCEPTED WITHOUT THE INSTRUCTOR’S APPROVAL.
Course Code Time Room Instructor Date/Signature
____________ __________ __________ _________________________________________________________________________________
____________ __________ __________ _________________________________________________________________________________
____________ __________ __________ _________________________________________________________________________________
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
Please return this form to the Enrollment Services Office on your designated campus.
Florham Campus, 285 Madison Ave., M-MS0-04, Hennessy Hall, Madison, NJ 07940 • Phone: 973-443-8600 • Fax: 973-443-8604
Metropolitan Campus, 1000 River Road, T-KB1-05, Kron Building, Teaneck, NJ 07666 • Phone: 201-692-2214 • Fax: 201-692-2209
BURSAR’S CLEARANCE
Tuition (if any) __________________________________________________________ Fees (if any) ___________________________________
Date ___________________________________________________________________ Initials ________________________________________
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 veterans status with regard to recruitment, admission or matriculation.
Rev. 11.16
PRINT
RESET
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit