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Information Thank you for your interest in Florida Keys Community College.

Please help us meet your needs by competing the following information request form.

The information you provide to FKCC is strictly confidential; it will never be sold or provided to other agencies.

As this information will be available to admissions should you become a student, please complete the form as accurately as possible. Please be advised that this is NOT an application for admission.

Required - indicates a required field.
Information Please provide your legal name, using a mixture of upper and lower case letters, as you would like it to appear on official documentation.
(Example: John Robert Smith)

Name
Prefix:
First Name: Required
Middle Name:
Last Name: Required
Suffix:
Nickname:

Information Please provide your current mailing address.
Address Line 1: Please enter your street address or PO Box using only abbreviations and upper and lower case letters.
(Example: 123 White St.)
If you have a Florida address, please indicate the county where appropriate.

Primary Address
Valid From: Month Day Year (YYYY)
Until: Month Day Year (YYYY)
Address Line 1:Required
Address Line 2:
Address Line 3:
City:Required
State or Province:
ZIP or Postal Code:
County:
Nation:
Phone Number: - (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)
International Access Code:

Information Please provide your primary e-mail address.

E-Mail Address
E-mail Address:Required
Verify E-mail Address:Required

Information Please provide your date of birth.

Birthdate
Date of Birth:Required Month Day Year (YYYY)

Information Please indicate the high school from which you graduated or will graduate. Click on the "Look Up High School Code" button below to locate your school; the address information will be filled automatically, or you may type it in if you fail to find it. Enter one of the following codes if you attended a non-US high school or earned a GED:

GED - GED

Non-US High School - A00003.

If you're not sure of the date of graduation or GED completion, use the first day of the appropriate month. (Example: June 01, 2007).

High School
Home Schooled (check for yes):
OR
High School Code:
High School Name:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State or Province:
ZIP or Postal Code:
Nation:
Graduation Date: Month Day Year (YYYY)
Class Rank and Size: / (must be numeric)
GPA: (example: 9.99, or A+)

Information Florida Keys Community College is very interested as to how you learned about the college. Please choose the best response from the pull-down menu.

How Did You Learn About Us?
How I Learned About FKCC:FKCC

Information Please indicate your expected term of entry into FKCC

Entry Term
Term of Entry:Required

Information Please indicate the student type that best describes you.

Student Type
Student Type:Required

Information Please choose the desired campus.

Information Please indicate your primary program of interest.

Programs of Interest
Major:Required

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Release: 8.5.4