Social Standing Form- Public

This form should be completed by a college official(s) such as a Judicial Affairs Officer or Dean of Students who has access to your academic and disciplinary records. Please send this form to a dean, advisor, or other college official who has access to your records and ask them to complete it. Florida Southern will notify you once we have received the submission.

Student Information

First Name

Last Name

Birthdate

Email Address

College Official Details

College or University Name

Name of College Official

Title

Phone Number

Summary of College Standing

Is this student eligible to return to your institution?

Yes

Is this student presently, or when last attending your institution, in good standing?

Yes

Please provide details of the student's academic standing.

Has this student experienced any disciplinary problems while attending your institution, whether related to academic misconduct or behavioral misconduct, that resulted in the applicant’s probation, suspension, removal, dismissal, or expulsion from your institution?

Yes

Please provide details on the nature of the student's disciplinary problems.

Are there any further comments you wish to provide to help evaluate this applicant?

I affirm the information provided above and I understand falsification of information provided in this document may impact the student’s admission and/or enrollment status at Florida Southern.

Yes

To affirm this information, please contact me by:

Phone

Date

Electronic Signature