FGCU Info Request Form

Contact Information

First Name

Middle Name

Last Name

Email Address

Confirm Email Address

Birth Date

(mm/dd/yyyy)

High School Graduation Year

(yyyy)

Do you want to enter your parent(s) information?

Select 'Yes' if you want to enter your parent(s)'s name and email address.

YesNo

Parent First Name

Parent Last Name

Parent Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email Address

Cell Phone

(XXX-XXX-XXXX)

Home Phone:

(XXX-XXX-XXXX)

Opt-in to Receive Text (SMS) Messages

I would like to receive text message.

I would like to receive text messages from FGCU Admissions at the phone number provided. Message frequency varies. Message & data rates may apply. Reply HELP for help or STOP to cancel.

FGCU SMS Terms of Service

Privacy Policy

Is this an International Address?YesNo

Complete Street Address (include APT, BLDG, or Unit)

City

State/Province

ZIP/Postal Code

Address Line 3 (Province and Postal Code)

Country

Select your student type, major and term:

What type of application would you be submitting to FGCU?

What is your academic program of interest?

If you are not yet sure of what you want to study, then select the Undecided option.

When are you hoping to start at FGCU?