Dean of Students' Office Certification/Clearance Request Form

Requester's Information

Please provide your information below.

Your first and last name:

Your phone number:

Today's Date(Required):

This field is required.

Please provide the following information:

Select your current status

DOB (YYYY-MM-DD)

Request Information

Please select one of the following options:(Required)

I authorize the Dean of Students' Office to release the information necessary to complete the attached Dean's Certification. You must upload a form for this option I authorize the Dean of Students' Office to write a letter detailing my conduct history at Florida Gulf Coast University.

This field is required.

University ID Number (UIN) :(Required) This field is required.

Eaglemail e-mail address (if you no longer have access, provide a current email address):(Required) This field is required.

Please provide the name(s), email(s) and/or fax number(s) of where the information needs to be sent.(Required) This field is required.

Supporting Documentation

Please provide the name, address or fax number of where the information needs to be sent in the "Additional Information" box above as needed. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Requester's Information

Please provide the following information:

Request Information

Supporting Documentation

Submission