Florida State Bachelor Degree College Application Form

In the case of an undergraduate student wanting to apply for a bachelor’s degree in the State of Florida, the following form has to be completed and submitted along with all of the necessary supporting documents.

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Educational Plans
Section IIIntended Starting Date: 	 Fall (August–December)     	 Spring (January–May)     	 Summer (May–August)     Year 	
Campus/Center Preference:	 	 Downtown Campus 	 Kent Campus 	 North Campus 	 South Campus	 	 The Cecil Center 	 Deerwood Campus 	 Nassau Campus 	 Navy Partners 	 Distance Learning 	 My main goal is to earn a bachelor’s degree. 
All applicants must have an associate degree or higher to be admitted to a program. All bachelor’s degree programs have selective admission. To be considered, applicants must meet or exceed the admissions requirements as established by each program. Program admissions material will be sent to you upon receipt of your student admission application.
 B.A.S. in Biomedical Sciences (T300)        	 B.A.S. in Public Safety Management (S400)  	
 B.A.S. in Business Administration (T200)     	 B.A.S. in Supervision and Management (S100) 	
 B.A.S. in Computer Systems Networking and Telecommunications (S300) 	 B.S. in Converged Communications (T400) 	
 B.A.S. in Digital Media (S500)    	 B.S. in Early Childhood Education (T100)	
 B.A.S. in Information Technology Management  (S301)     	 B.S. in Nursing (N200)	
 I am a student at another college or university; my main goal is to take \
one or more credit courses to transfer to my primary institution (S000).	
Bachelor’s Degree 	 	
Application for Student Admission	
Return this application and your non-refundable $25 application fee to any campus/center or mail to the Admiss\
ions Office, Florida State College, P.O. Box 2550, Jacksonville, FL 32203-2550. Please make your check or money order payable to Florida State College at Jacksonville.
Name	 Last      First      Middle	        	Previous Name	    	 	If Any	
*Social Security Number	       	Telephone	 	Home or Cell  	          Work	  	
*In compliance with Florida Statute 119.071(5), Florida State College \
at Jacksonville issues this notification regarding the purpose of the collection and use of Social Security numbers. Florida St\
ate College will collect your Social Security Number (SSN) for use for legitimate \
business purposes which include record identification, state and federal reporting. Providing your SSN on this application mean\
s that you consent to the use of your number in the manner described. If you choose\
 not to provide your SSN, you will be provided an alternate identification number. All Social Security Numbers are protect\
ed by Federal regulations and are not to be released to unauthorized parties. \
Read more about the collection of Social Security Numbers in the College Catalog and on the College Web site.
Mailing Address	  	                      	Number and Street/Apt. # or P.O. Box	  	        	
 City       State        ZIP Code       	E-mail	
Emergency Contact	       	  Name	                    	Relationship to Applicant	  	
Telephone	                   	Home or Cell          Work	                	E-mail	 	
Gender:  	 Female  	 Male  	 Date of Birth	       	Country of Birth	                 	Country of Citizenship   	
    	Month  Day    Year	      If not a U.S. citizen, please attach a legible copy of your Visa and I-94 card or resident alien card.	
Primary Language:	  	 English  	 Spanish  	 Other   	         	Visa Type	            	Alien Resident?	 	 Yes  	 No 	Alien Number	
Information submitted in this section of the application will not be use\
d in the admission process.	  	
Are you Hispanic/Latino ?   	 	 Yes   	 No	
Please select the racial category or categories with which you most clos\
ely identify. Select one or more categories:
 American Indian or Alaska Native     	 Asian     	 Black or African-American     	 Native Hawaiian or Other Pacific Islander     	 White	   	
(        )        (        )	
(        )       (        )	
Personal  	                             	
Section I	
College/University  City   State/Nation  Degree Earned  Field of Study
Have you graduated or will you graduate from High School?	  	 Ye s	  	 No	  If yes, check diploma earned:	  	 Standard	 	 Equivalency 	Degree	
List all colleges or universities that you have attended. Do not abbrevi\
ate school names. Attach additional sheet if necessary.
High School or Equivalency Degree test site   City   State 
Educational History 
Section III	
Graduation Date	
Office Use Only:   POS	 _________	Major	 __________	Admission Code	 __________	Status	 _________	Residency	 ___________	Entered by	 __________	Campus/Center	 _________	Date	 __________	
I agree to the release of any transcripts and test scores to this institution, including any score reports that this institution may request from the 
College Board or ACT. I understand that falsification or omission of application information may result in penalty. 
FLORIDA RESIDENCY	-I understand that in order to qualify for Florida residency for tuition purposes for the term for which this application is\
 	submitted I must complete a Residency Affidavit prior to the beginning of the term.  I understand that if I do not submit a 	Residency Affidavit with 	supporting documentation	, I will not be eligible for in-state tuition rates.	
Applicant’s Signature ______________________________________________________________________\
_______ Date_________________________
Florida State College at Jacksonville provides equal access to education, employment, programs, services and activities and does not discriminate on the basis of age, race, color , national origin, sex, disability, religious belief, or marital status. The College Equity Officer has been designated to handle inquiries regarding the non-discrimination policies and may be contacted at [email protected]. Florida State College at Jacksonville is a member of the Florida College System and is not affiliated with any other public or private university or college in Florida or elsewhere. Florida State College at Jacksonville is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award the baccalaureate and associate degree. Contact the Commission on Colleges at 1866 Southern Lane, Decatur , Georgia 30033-4097, or call (404) 679-4500 for questions about the accreditation of Florida State College at Jacksonville. The Commission is to be contacted only if there is evidence that appears to support an institution’s significant non-compliance with a requirement or standard.