MELBOURNE CAMPUS STUDENT REQUEST
TO REGISTER FOR ONLINE COURSE
TERM FOR REGISTRATION Date of Request _______________________________________________
¨Fall (16-week) ¨Fall 1 (8-week) ¨Fall 2 (8-week) ¨Spring (16-week) ¨Spring 1 (8-week)
¨Spring 2 (8-week) ¨Summer (11-week) ¨Summer 1 (8-week) ¨Summer 2 (8-week)
Student Name ____________________________________________________________________ Student ID No. __________________________________________
Last First
Phone Number* ___________________________ College ______________________________________ Major ________________________ Major Code _________
*By entering your mobile number, you agree to receive text messages from FL Tech 55678. Consent is not required to purchase goods or services. Approx. 5 msgs/mo. Msg/Data
rates may apply. Reply HELP for help. Reply STOP to cancel. https://www.t.edu/freshman-admissions/text-messaging/
________ _________ ____________    _____________________________________________________________________________________________________
CRN Prex CourseNo. CourseTitle
________ _________ ____________    _____________________________________________________________________________________________________
CRN Prex CourseNo. CourseTitle
JUSTIFICATION FOR REQUEST
StudentSignature ________________________________________________________ Date ________________________________________
oMy advisor has contacted the department oering the course(s) and has determined I’ve met the course(s) prerequisites
   and the course(s) meets my graduation requirements.
I am a sponsored international student oYes oNo
Has your sponsor approved this course? oYes* oNo (*AnancialguaranteefromthesponsormustbeonleinStudentAccountManagement;conrmedbysignaturebelow)
StudentAccountManagement _____________________________________________________________________________  Date ____________________________
Advisor Name ______________________________________________________________________________
AdvisorSignature ________________________________________________________________________________________ Date ____________________________
Dean or Designee Name _____________________________________________________________________
DeanorDesigneeSignature _______________________________________________________________________________ Date ____________________________
DeanorDesigneesignaturenotneededforSummer1orSummer2terms,or16-weekonlinecourses
RGR-464-0220
REGISTRAR’S USE ONLY
Processed by ______________________________________________________________________________ Date ___________________________________________
After all signatures are axed, take to the Oce of the Registrar for processing. Specic restrictions may apply. For Summer Terms only,
undergraduate discounts may apply. Sponsored international students must contact their sponsor for specic exceptions.
See college/department for additional information. Late requests are not accepted.
By signing this form, the student and advisor acknowledge their responsibility to know start and withdrawal dates.
The maximum course load in an 8-week term is two courses. Registration deadline for 8-week online courses is 12 days before the start
of the term requested; 16-week deadlines are published in the academic calendar. Late requests not accepted.
Florida Institute of Technology § Oce of the Registrar § 150 West University Boulevard, Melbourne, FL 32901-6975 § 321-674-8115 § Fax 321-674-7827