Last Name First Name

wish to cancel my application currently on file at FLORIDA ATLANTIC UNIVERSITY.

E-mail Address

I understand that if I wish to reinstate my application, an additional application fee and/or documentation might be required.

Last 4 digit of Social Security No.

Submission of this document serves as your electronic signature. Submission of information online certifies that the information provided is complete and correct to the best of your knowledge. Any use of false names or identities is considered fraud.