Adult & Graduate

Recertification/Teacher Workshop Application

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Recertification/Teacher Workshops Application - All Sessions

Section 1: Biographical Information
Page 1 of 3
Entry notes:
       --- This info is for an official record; please use your legal name
       --- Please utilize proper grammar and letter casing
1. 
Name Prefix:
2. 
First Name:
*Required, Maximum characters allowed: 30
3. 
Middle Name:
Maximum characters allowed: 30
4. 
Last Name:
*Required, Maximum characters allowed: 60
5. 
Suffix
6. 
Other Last Names Used:
7. 
Nickname:
Maximum characters allowed: 15
8. 
Former Last Name:
Maximum characters allowed: 30
9. 

SSN: (Financial Aid/Transcripts/Degree Verification will require SSN)

Format: 123-45-6789
10. 
Date of Birth:
*Required, Format: mm/dd/yyyy
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11. 

Gender:

12. 

Personal E-mail Address:

We will be sending all email correspondence to your personal email account and not your school/work email.

*Required, Format: x@x.xx
13. 

Alternate E-Mail Address:

Format: x@x.xx
14. 
Address Line 1:
*Required, Maximum characters allowed: 60
15. 
Address Line 2:
Maximum characters allowed: 60
16. 
City:
*Required, Maximum characters allowed: 25
17. 
State:
18. 

Florida residents, select your county:

19. 
Zip:
Format: 12345 OR 12345-6789 OR 123456789 OR A1B 2C3
20. 

Country of Address:

*Required
21. 
U.S. Citizen:
*Required
22. 

Country of Citizenship:

*Required
23. 
Cell Phone:
*Required, Format: 123-456-7890
24. 
Home Phone (if the same as your cell#, please leave blank)        
Format: 123-456-7890
25. 

Have you ever applied or attended FSC?

*Required
26. 

If yes; what year did you apply/attend?

27. 
If yes; FSC Student Id:
28. 

Florida Department of Education (DOE) Certification Number:

*Required
29. 

Academic year in which you plan to enroll:

*Required
30. 

School District:

31. 

Reason For Applying:

32. 
  How did you hear about FSC?
*Required
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