ERROR:
JavaScript is not enabled. You must enable JavaScript in your browser to use this form
Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit Form
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Fields
Contact Information
Name
*
First Name
*
Last Name
*
Email
*
Cell Phone
*
Zip Code
*
ZIP Code
High School Graduation Year
*
Additional Information
What Degree Or Certification Are You Interested In?
Bachelors In Clinical Laboratory Science
Clinical Laboratory Science Certificate
Molecular Diagnostics Certificate
Select one of the following from dropdown
Student Type
Freshman - No Credits After High School Graduation
Transfer - Have Credits After High School Graduation
Select one of the following from dropdown
Current Level Of Education
Associates Degree
Earning A Bachelors Degree
Bachelors Degree
Earning A Masters Degree
Masters Degree
Earning A Doctorate Degree
Doctorate Degree
Other
Select one of the following from dropdown
Checkbox
*
By submitting this form, I am providing my digital signature agreeing that Florida Gulf Coast University may email me or contact me regarding educational services by telephone and/or text message utilizing automated technology at the telephone number(s) provided above. I understand this consent is not a condition to attend FGCU or to purchase any other goods or services.
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm