Fillable form must be submitted to the Office of (Florida Gulf Coast University)

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1
Request to Change Admission Term
Office of Undergraduate Admission
This
form must be submitted to the Office of Undergraduate Admissions no later than 1 week prior to the payment
deadline. Forms received after that date will not be accepted.
Date:
University ID #:
First Name:
Last Name:
Are you
attending another college/university before the term you intend to enroll at FGCU?
*Admitted
students attending another college/university must reapply.
Name of college/university:
Original Term:
I was accepted into the semester of ________
(year) to major in _______________.
New Term:
I wish to change my acceptance to the semester of ________(year).
Reason(s) for deferring:
Street Address:
Telephone Number:
City: State:
Zip Code:
E-Mail Address:
Conduct Disclosure: Applicants must answer the following questions to complete the admissions process.
1. Are you cur
rently, or have you ever been, charged with or subject to disciplinary action for scholastic (such as plagiarism or
cheating) or any other type of behavioral misconduct at any educational institution? You do not need to disclose academic
dismissal, suspension or probation for poor grades.
2. Have you ev
er been charged with a violation of the law, misdemeanor and/or felony (even if adjudication was withheld) which
resulted in, or, if still pending could result in, probation, community service, restitution, a jail sentence or the revocation or
suspension of your driver’s license (you are not required to include traffic violations which only resulted in a fine)?
If you m
arked “YES” for one or both questions, you must provide a full explanation and copies of all official court/educational
documents - go to the Admissions Clearance Conduct Form for more details.
Applic
ation Signature and Certification:
By signing this document, you certify that the information given on this form is complete and accurate, and you understand that to
make false or fraudulent statements may result in disciplinary action, denial of admission and invalidation of credits or degrees
earned. If admitted, you agree to abide by the policies of the Board of Governors and the rules and regulations of this university.
You understand the requirements of changing your admission term as stated below. You further understand that admission to the
university does not necessarily guarantee admission to limited access programs, and that further application materials may be
required for these programs prior to admission. You agree to the release of any transcripts and test scores to FGCU; moreover, you
understand that all documents submitted to Undergraduate Admission become the sole property of FGCU and may not be released
to the applicant or a third party.
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2
Requirements:
1. Admitted students may defer their enrollment for a full year and do not have to reapply. Denied students must submit a new
application with fee and cannot submit this form.
2. Students attending another college/university, or that have been accepted into the nursing program, may not change
terms.
3. If the change of term request is approved and student has paid the deposit, then their $200 Admissions Deposit will be credited
to the new term.
4. International students are required to provide new Financial Documents before a new I-20 is issued.
5. Freshmen must provide a final high school transcript showing date of graduation before they can start their new term.
6. Students changing their term of admission must notify the Registrar’s Office to ensure proper withdrawal from classes
to avoid tuition & fee charges. They should contact the Financial Aid and Housing offices as well.
7. Students awarded a Tuition Waiver must re-apply for a waiver for the new term.
8. Admissions into the new term is not guaranteed as these requests will be processed based on space availability and
admissibility into the new term.
You may submit this form by emailing it to undergrad@fgcu.edu, faxing it to 239-590-7894, or mailing it to 10501 FGCU
Boulevard South Fort Myers, FL 33965-6565.
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Completed 20 August 2020

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