Florida International University
Office of the Register
Non-Degree Seeking Student Application Form

Please Note: This is not an application for Admission to a degree program at the University. Students desiring admission to a degree program must fill out an Admission Application with the Office of Admissions.

Note: If your address has changed since your last attendance at FIU, please fill out a Change of Address Form

Important: Have you ever received a grade from FIU?  Yes __    No  __

Non-degree seeking students have an affiliated or unaffiliated status. Affiliated non-degree seeking students must be approved by the appropriate School or College and must meet its specific requirements. Unaffiliated non-degree seeking students are limited to one semester courses at FIU.

If a non-degree seeking student changes to a degree-seeking status, only 15 credit hours taken as an undergraduate non-degree seeking student will apply toward the graduation requirements at FIU; or 12 credit hours as a graduate non-degree seeking student.

international students holding an F-1 visa cannot register as non-degree seeking students.

Social Security Number (SSN):|__|__|__| - |__|__| - |__|__|__|  Term:____________________

Name: (Print, one character per block.  Leave one block between names)
last Name                                                                    First Name                                                                             M.I

Permanent Address:

Number and Street                                                    City                     County           State         Country    Zip Code      

Local Address:

Number and Street                                                    City                     County           State         Country    Zip Code

Telephone Number:  Area Code:_______     Number:______________

Nation of  Citzenship:________________    Place of Birth: ____________    Birthdate:________________

Sex:   Male ___    Female  ___

Race: (required by U.S. Department of HEW under Title VI of the Civil Rights Act)

(A) - Asian or Pacific Islander  ____        (B) - Black (not of Hispanic origin) ___      (H) - Hispanic: __
(I)  American Indian or Alaskan Native:  ___            (W) - White (not of  Hispanic origin):____

Institution where most coursework or highest degree was granted:________________________________

Dates Attended: ________________ Highest degree earned: ____________   Date received: ___________

Have you ever been found by any school authorities or by any court to have disrupted or interfered with the orderly conduct, processes, functions, or programs of any other educational institution? Yes:__ No: __

If  ‘yes’, please give details: _____________________________________________________________


Are you currently charged or have you been convicted or found guilty (even if adjudication withheld) of violating any federal or state law or municipal ordinance other than minor offenses involving a fine of $500.00 or less?  Yes: __   No: __

If ‘Yes’’please give date, name of court, nature of offense, and penalty imposed, if any:__________________


Resident Alien Students: Alien Card number:____________________   Date Issued:_______________



       A Florida “resident for tuition purposes”  is a person who has, or  a dependent person whose parent of legal guardian has, established and maintained legal residence in Florida for at least twelve months.  Residence in Florida must be as a bonafide domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of higher education  To qualify as a Florida resident for tuition purposes you must be a U.S. citizen, permanent resident alien, or legal alien granted indefinite stay by the Immigration and Naturalization Service.  Other persons not meeting the twelve-month legal residence requirement may be classified as Florida residents for tuition purposes only if they fall within one of the limited special categories authorized by the Florida Legislature and Board of Regents.  All other persons are ineligible for classification as a Florida “resident for tuition purposes”.  Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend on out-of-state parents for support are presumed to be legal residents of the same state as their parents.


I understand that I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted and that if I should qualify for some future term it will be necessary for me to file the required documentation prior to the beginning of the term in order to be considered for Florida residency classification.

                 Signature in ink:_______________________________  Date______________________


- Person claiming residency should complete this section in full.
- Documents supporting the establishment of legal residence must be dated, issued or filed 12 months before the first day of classes of the term for which a Florida resident classification is sought. All documentation is subject to verification.
- Additional documentation maybe required in some cases.

1. Name of student: _________________________________  2:  Student Social Security___/___/___

3. Name of person claiming Florida residency____________________________ 

4. Claimants relationship to student______________________________

5. Claimant’s permanent legal address:_________________________________________________

6. Claimant’s Telephone Number:  (____)_____________________

7. Date claimant began establishing legal Florida residence and domicile:____/____/____

8.  Claimants voter registration:    State:________ Number_________County________ Issue date___/___/___

9. Claimants driver license             State:________ Number_________County________ Issue date___/___/___

10. Claimants vehicle registration State:________ Tag Number___________________ Issue date___/___/___

11. Non-U.S. Citizen only. Resident Alien Number:_____________________________Issue date___/___/___
  (Copy of both sides of card required)

I do hereby swear or affirm that the above named student meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06 Florida Statutes and to BOR Rule 6C-6.001(6), F.A.C.

__________________________________________________________________     _______________
Signature of person claiming Florida residency (as listed in item 3 above)                               date