Authorization for International Students
to Enroll as a Non-Degree Student
Instructions: Once you complete the top section of the form, please submit form and required documents to
Office of International Student & Scholar Services via email to [email protected] with the subject line “NON-DEGREE
APPLICATION”. Due date: The form must be submitted one week prior to the last day to Submit Non-Degree
Application.
Personal Information
Name: ____________________________________________________________ Panther ID: ________________________
Address: _____________________________________________________________________________________________
Birthdate: ___________________________________ Email Address: ____________________________________________
Visa Type: _____________________________________________ I-94 Expiration Date:_____________________________
Attachments:
_____ Copy of Visa and Passport (required)
_____ Copy of I-94 card (required)
_____ Copy of I-20 and International Advisor letter (required)
_____ Copy of medical insurance card, front and back (required)
_____ Copy of Employment Authorization Document (EAD Card)
_____ Other _________________________________________
For ISSS Use Only:
Medical Insurance (Circle One):
Yes or No - Must satisfy medical insurance requirement.
The international student above ___ is ___ is not eligible to enroll as a special student for the
___ Fall ___ Spring ___ Summer term of 20___.
_______________________________________
__________________________
Authorized Signature
International Student & Scholar Services
Date
Office of International Student & Scholar Services
1401 S.W. 108th Avenue. • Modesto A. Maidique, SASC 230 • Miami, FL 33199 • Tel: 305-348-2421 • Fax: 305-348-1521 • www.fiu.edu/~isss