REGISTRAR’S OFFICE
1735 Wahnish Way, C.A.S.S. Bldg., Suite #206 – T a l l a h a s s e e , F L 3 2 3 0 7
Office: (850) 599-3115 Fax: (850) 561-2428 Email:
[email protected] Transient Student Form
SECTION A: TO BE COMPLETED BY STUDENT APPLICANT. Please print. Yes No
Are you receiving financial aid for course(s)? ✔
300439963
Student I.D.: ________________________________ Date of Birth: ____________________________
02/03/05
Sims
Last Name: _________________________________________ Brent
First Name: __________________________________ A
MI ___________
505 James Ridge Ln
Permanent Address: ____________________________________________________________ (
770 549-5824
) ______________________
(Number, Street, Apt. #, City, State, Zip Code) (Area Code) Telephone Number
Clayton State University
Receiving University/College______________________________________________ Term: Fall ___ Spring ___ Summer___ _________ ✔ 2025
(Institution you will be attending) (Year)
I understand that if I register for courses not approved herein, I assume the full risk of transferability. I also understand that this application is for the ONE TERM
specified; that I must provide FAMU with an OFFICIAL TRANSCRIPT from the receiving school and authorize the release of such records accordingly.
Signature of Student: ___________________________________________________________________
4/1/2025
Date: _____________________
SECTION B: TO BE COMPLETED BY ACADEMIC ADVISOR. The above named student is hereby authorized to take the following
course(s) during the one term specified.
Prefix Course # Hours Course Title FAMU School Equivalent
1.___________ ______________ _______ _____________________________________ _______________________________________
______
2.___________ ______________ _______ _____________________________________
_______________________________________
______
3.___________ ______________ _______ _____________________________________
_______________________________________
______
4.___________ ______________ _______ _____________________________________
_______________________________________
Advisor’s Signature: _____________________________________________________ Date: ______________________
Chairperson’s Signature: _____________________________________________________ Date: ______________________
Dean’s Signature: _____________________________________________________ Date: ______________________
SECTION C: TO BE COMPLETED BY THE REGISTRAR’S OFFICE
Yes No
___
✔ ___ The above named student is regularly enrolled in a degree program and eligible to re-enroll.
___ ___ The student has a Student Health form on file indicating the required Measles and Rubella immunities.
___ ___ Does the student have outstanding financial obligations?
The student’s residency classification for tuition purposes is: Official Seal Here
____ Florida Resident ____ Non-Florida Resident ____ Resident Alien ____ Documented Alien
Signature of Registrar: ________________________________________ Date: _____________
Rev. 2-23-24: mjs
DocuSign Envelope ID: E341D82A-4A02-47F8-9014-6AE96BD65823
Transient Supplemental Form
Florida A&M University, Office of International Education and Development (OIED)
1740 S. Martin Luther King Blvd., Perry Paige, Suite 302N, Tallahassee, FL 32307-3100
Tel: 850-412-7077 / Email:
[email protected] Student Information
Student ID Number: DOB:
Student Name:
Last First M.I.
Email Address:______________________________Telephone Number: ___________________________________
Program Type: Study Abroad ☐ Undergraduate ☐ Graduate
☐ FAMU Student ☐ Internship ☐ Service Learning ☐ Exchange
☐ CO-OP
Education Abroad Program Information
Number of Credit Hours: _________________ Financial Aid from FAMU : Yes ☐ No ☐
Proposed Program Name: Country/City
Host University: Sponsored by
Program Approval
The student has been approved by OIED for the education abroad program indicated above and is referred to
her/his academic advisor.
Education Abroad Coordinator Date
