Initial
Initial
Natural Disaster Request for Exemptions
Use for 2017-18 Displaced Students from Puerto Rico or the US Virgin Islands
Per Florida Department of Education (FDOE) Emergency Order “Removing Obstacles for Florida College System Institutions Enrolling
Students Displaced by Hurricane Maria", Eastern Florida State College (EFSC) will grant temporary in-state tuition to eligible applicants.
The Emergency Order specifically includes individuals who were enrolled in or planning to be enrolled in a postsecondary institution
in affected areas and are seeking enrollment in a Florida postsecondary institution while the Emergency Order is in effect. However,
it does not discriminate against individuals from affected areas who were not enrolled in a postsecondary institution but now are
seeking education or re-training opportunities. Students enrolling under this Emergency Order are considered to be in-state residents
for tuition purposes for the 2017-18 academic year, in accordance with established institutional policies which may include a provision
of continuous enrollment.
Name: ____________________________________________________________________________________________
Please Print Legibly
Prior Address: ______________________________________________________________________________________
Street Address City State/US Territory
Florida Address: ____________________________________________________________________________________
Street Address City State
_______ _______ Government/College Issued ID Provided Date Arrived in Florida: ____________________
Student or Parent (if student is under 18)
Documents accepted: current voter’s registration card, current driver’s license, current identification card, current
vehicle registration, current college ID, FEMA application from hurricane-affected area, insurance claim due to hurricane
damage from affected area
Reason for Relocation: _______________________________________________________________________________
Term of Enrollment Request: Spring 2018 Summer 2018
Preferred Campus: Cocoa Melbourne
Palm Bay
Titusville
_______ I
verify that I graduated from high school with the equivalent of a U.S. standard high school diploma.
Initial
High School Name: _____________________________________________ Graduation Date: _____________________
I attended the following college(s): Complete the back side of this form if you attended more than one college
College Name: _____________________________________________________________________________________
Dates Attended:____________________________________________________________________________________
List previous course work and grades, if unable to provide unofficial transcripts: ________________________________
_________________________________________________________________________________________________
HONESTY STATEMENT
I am 18 years of age or older and a displaced resident of Puerto Rico/U.S. Virgin Islands. I understand that I am eligible for
the in-state tuition rate for the 2017-18 academic year. This exemption will expire effective the Fall 2018 academic term.
_______I verify that the information above is accurate and complete to the best of my knowledge. I understand, if at a later date, any
information is found to be inaccurate it may affect my EFSC transcript, degree completion, tuition rate or financial aid.
_______I understand that it is my responsibility to provide final, official transcripts from high school and all previously attended colleges
within six months or prior to graduating from an EFSC program. Unofficial transcripts may be used for course placement
purposes, but no transfer work will be awarded without official transcripts.
Student Signature: __________________________________Phone Number: _____________________Date:__________
Approved by:_________________________________________________________
Date:
________________________
Admissions Director
SC-189 R101117
Parent Signature: (if student is under 18) _____________________________________________________ Date:__________
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