Rev. 2/10
Palm Beach State College
Office of the Registrar
REQUEST TO ENROLL AT ANOTHER COLLEGE
Please check one box: CONCURRENT ENROLLMENT TRANSIENT STUDENT
(Concurrent enrollment at Palm Beach (Enrolled at another college for one
State and another college) term, planning to return to Palm
Beach State)
Students requesting study at a Florida public institution must process the form online at FACTS.org if the
receiving institution participates.
Name _______________________________________ Social Security No. _______________
Palm Beach State Student ID ___________
Address ______________________________________________________________________
CITY STATE ZIP
This form will authorize the above student who is currently enrolled at Palm Beach State College to also
enroll at ____________________________________________________________________________
(Regionally Accredited College or University)
in the course(s) listed below for Fall Spring Summer A Summer B Term(s) of ________ .
YEAR
Please briefly state the reason for the above request: _________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
This student is classified as a Florida Resident Non-Florida Resident
Please note:
1. Fifteen (15) semester hours toward a degree must be earned in residence at Palm Beach State.
2. If the request is granted, the approval is only for the specific school, course(s), and term(s) listed above.
3. The course(s) will be evaluated under Palm Beach State's standard policy.
4. Official transcripts of the above course work must be sent to the Palm Beach State Registrar's Office
immediately upon completion.
5. Unless otherwise noted, this student is eligible to return to Palm Beach State.
______________________________________ ________________________________
Student’s Signature (Required) Palm Beach State Advisor’s Signature (Required)
________________________________
Palm Beach State Registrar’s Signature (Required)
