REQUEST FOR PROGRAM INFORMATION

Thank you for your interest in our programs. Please complete the form below and we will provide you with more information about our University.

Thank you. You will receive the information in a few days...
Dawn Fagnan, Enrollment Manager (Dawn.Fagnan@fiu.edu)

Personal	All Fields Required
First Name:
Last Name:
Email Address:
Phone Number:		Please include area code -or- country code for phone numbers outside the US.

Address
Street:
City:
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Zip Code:
Country:	United States Argentina Australia Austria Bahamas Bahrain Belgium Brazil Bulgaria Cameroon Canada China Colombia Cyprus Czech Republic Denmark Ecuador Egypt Ethiopia France Germany Greece Guam Hungary India Ireland Israel Italy Jamaica Japan Kenya Luxembourg Madagascar Malaysia Maldives Malta Mauritius Mexico Morocco Netherlands New Zealand Nigeria Norway Oman Romania Saint Lucia Saudi Arabia Singapore South Africa South Korea Spain Sri Lanka Switzerland Taiwan Thailand Trinidad/Tobago Tunisia Turkey U.A.E United Kingdom Venezuela Uruguay Vietnam
Other Country	(if not listed above):

Academic
Current Grade Level:	Please Select 9th Grade 10th Grade 11th Grade 12th Grade High School Graduate College Freshman College Sophomore College Junior College Senior College Graduate
Last School Attended:
Graduation Date (year):
Gender:	Please Select Male Female	Date of Birth (mm/dd/yyyy):

Interested In:
Bachelor's Degree		Entering as Freshman	Entering with Transfer Credits
Master's Degree		On Campus Distance Programs Both
Doctoral Degree
Certificate Programs
Anticipated Date of Entry:	Please Select Spring 2008 Summer 2008 Fall 2008 Spring 2009 Summer 2009 Fall 2009 Spring 2010 Summer 2010 Fall 2010		Major: Please Select Hospitality

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