Student Registration

* First Name: * Last Name:
*SSN: --
*Re-enter SSN: --

*Student ID: --
* Date of Birth: / /   ( MM / DD / YYYY )
Gender: * Ethnicity:
*Number living in household? *Family income:  

* Are you receiving any public assistance: TANF, foster care services, food stamps, or Supplemental Security Income?
* Are you currently enrolled in a CareerSource South Florida program?

  Are you currently living on campus (FMU)?

*Current Address:
(Example: 7300 NW 19th Street)
House Number: Direction: Street Name: Street Type: Apt:
(Ex: 7300) (NW) (19) (St)  
*Zip Code: * Telephone: () -

Permanent Address:

*Zip Code:

*School / FMU Email: *Personal Email:

*Are you attending school?
*Highest Level of Education Completed:
*What is your Major:
* Are you a U.S. Citizen?
*Have you registered with the Selective Service?

Are you currently in a Work Study or Internship?
Employer's Name: Position/Title:
Skills/Duties: (Max 200 Chars)

What careers are you interested in?
Choose a Occupation Family
Choose an Occupation

Are you requesting auxiliary aids and services for individuals with disabilities?

Please be sure to select your top choice for occupation.

For information, call: 305-626-3734
CareerSource South Florida is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.
All voice phone numbers listed on the page may be reached by dialing the Florida Relay # 711