Admission and Registrar Forms

We hope the convenience of online services makes your life easier! Anything you can do online with our office can also be accomplished in person on the Lakeland or Winter Haven campus and at the JD Alexander or Airside Center. Electronic forms are submitted through our Etrieve system. All other paper forms must be submitted in person or mailed to:

Polk State College
Admission and Registrar’s Office
999 Ave. H NE
Winter Haven, FL 33881-4299

If you are a Student with Disabilities and need assistance with forms, contact the Admissions and Registrar’s office at 863.289.1000 or come into any campus or center’s Admission and Registrar’s office. You may also see a Disabilities Service Advisor on either the Lakeland or Winter Haven campus

Residency Declaration

You can submit the Residency Declaration as an electronic form through our Etrieve system or you can visit any of our Admission and Registrar offices to obtain the paper form. When using Polk State’s electronic forms through Etrieve for the first time, please see our Etrieve Activation and Documentation Instructions.

Copies of all documentation must accompany the Residency Declaration. For further details on residency requirements, go to Guidelines to review Florida state statutes or check out the Admission Steps.

Students who wish to appeal a residency decision may do so to the Residency Committee. Fully complete the Residency Declaration, complete the petition section on the back page of the Residency Declaration, and submit it with supporting documentation to the Admission and Registrar’s office on any campus or at the JD Alexander Center.

Residency Affidavit of Parental Role
If the student is under 24, a relative or another person who is acting in a parental role to the student intends to use his or her documents to claim in-state tuition for the student, this form must be completed and submitted with a residency declaration.

Residency Affidavit of Family Ties
If the student is at least 24 years old and lives with a relative, the Residency Affidavit of Family Ties may be used as part of the student’s residency documentation to claim in-state tuition if the student does not have a Group B document of his or her own. The relative with whom the student lives will complete and sign the Residency Affidavit of Family Ties. The Affidavit must be completed and submitted with a residency declaration.

Transcript evaluation is completed in two stages at Polk State. The first stage, the initial evaluation, is entering your transfer credits onto your record. This is generally completed within one week of receiving your previous institution’s transcript. This meets the requirement to provide Polk State College transcripts from previous institutions you have attended and qualifies the release of Federal Financial Aid that has been awarded to you. The second stage is mapping your transfer credits to Polk State’s courses and into Polk State’s degrees. This takes up to six weeks from the date that stage one of transcript evaluation is completed. You can log into PASSPORT, and see the date your transcript was received.

Once stage two of your transcript evaluation is completed, you may challenge a decision or request additional credit, by completing the Transfer Action Request form. You will be required to provide a copy of the course description and/or syllabus as an attachment to this request. The more information you provide, the easier it is for the transcript evaluator to review.

If you have difficulties completing the form email for assistance. Requests that are submitted prior to six weeks from the date of the stage one evaluation will not be answered or reviewed.

When using Polk State’s electronic forms through Etrieve for the first time, please see our Etrieve Activation and Documentation Instructions.


  • Available 24/7 through National Student Clearinghouse.
  • When the National Student Clearinghouse website opens, select the “Verify a Degree” link.
  • If you do not have one, you will be asked to create a username and password.


Option #1:

  • Provided to students one week after drop deadline for term or session.
  • Available 24/7 through National Student Clearinghouse.
  • Go to the Polk State College website:
  • Click on PASSPORT.
  • Enter student ID and password. (If you do not know your student ID, you can use your SSN.) The password default is the first two digits of your birth month and the last two digits of your birth year. Ex. 3/12/1985 would be 0385.
  • Click on “Records.”
  • A dropdown box will appear, select “ENROLLMENT CERTIFICATION.”
  • Select “Click Here.”
  • Click on “Obtain Enrollment Certificate.” (The system will automatically default to “Current Enrollment.”)

Option #2

  • Students can email forms to For loan deferment, students will need to have the first sections of the paperwork from their lender completed before emailing it to NSCH.
  • To speak to a representative at the National Student Clearinghouse, please call (703) 742-4200, then dial 3 or email questions to

Most outgoing transient forms are done online through Your transient form will be processed by Polk State College generally within two days. You will receive notification by email. If the school you are attending does not accept electronic transient forms, you must see an advisor to get transient approval in person.

If you are taking a course at Polk State College as a transient, from most state community colleges or universities, use the electronic transient form. If your institution does not use the transient services, then have your institution provide a transient letter or form with the courses you are allowed to take. You will not need to complete an application if you use the electronic incoming transient form.

Check your student information at least once a term. If changes need to be made to any of your vital information, complete a Vital Statistics Change Form. This form requires proof of legal change of name or social security number. Submit these forms in person with the proof or email the form with an image of your proof to

Polk State College is committed to the protection of student rights and privacy of information. We comply with the provisions of the Federal Family Educational Rights and Privacy Act (FERPA). For more information, go to FERPA or read Polk State’s notification of rights under FERPA in the current catalog. It is found in the Admission, Advising, Registration and Records section.

If you want to give permission to your parent, spouse, or other to get information about your private academic record, you must complete the FERPA Release Form in person with proof of identity.

If you want to restrict all of your information from any kind of public disclosure, you must complete a FERPA Non-Disclosure Form. You must meet with the Registrar to discuss non-disclosure. This form cannot be completed and mailed or faxed.

At any time you want the non-disclosure status removed, complete a Vital Statistics Change Form. Both of these must be submitted in person with proof of identity.

If you earned a GED, you must request that it be sent to Polk State College within 30 days of your first term. This applies to Florida and out-of-state GEDs.

How do Florida students send a 2014 GED to Polk State College through GED Credentialing?
As soon as you pass the 2014 GED® test, you will receive a secure, electronic PDF document delivered to your email that contains your Smart Transcript and diploma. This email will be sent to the email address you provided when you signed up for MyGEDTM. You can forward this email containing both your Smart Transcript and diploma to GED Credentialing™ uses Blue Ribbon™ Security. Blue Ribbon™ Security guarantees that transcripts or diplomas you send out have not been altered. We will be able to use this technology to assess the integrity of your transcript. We will not accept any transcripts that we suspect have been altered.

If you earned a Florida GED prior to 2014, you will request your credentials from GED Credentialing™.

Be aware of fraudulent GED providers and diploma mills that give you a test to earn a high school diploma. See this official GED Testing Service website for help.

If you graduated from homeschool, your primary educator must complete this form. It should be submitted within 30 days of your first term.

If you attended a Florida high school, Polk State College can receive the transcript through FASTER electronic transmission. Request that your high school sends a transcript after you complete a Polk State College application. If your high school is out of state or does not participate in FASTER, then submit a request directly to your school.
It is very important that your high school and college records have the same information under Name, Date of Birth, and SSN. If they are different, your high school transcript will not electronically post to Polk State College. Please verify this information before ordering your transcript.

Student Petition Form
Students who have experienced extenuating circumstances that have affected academic performance, attendance, or requirements during a term may petition the college for a policy exception. Students must see an advisor for submission of a petition.

Collection and Use of Social Security Numbers
Pursuant to Florida Statute 119.071(5), Polk State College wants to inform you of the reasons we collect social security numbers. Please download and read this explanation.

State employees may qualify for a tuition waiver for certain classes. For more information go to the State Employee and Classroom Teacher Information Page.

Classroom teachers may qualify for a tuition waiver for certain classes. For more information go to the State Employee and Classroom Teacher Information Page

Withdrawn or Dropped for Not Attending
If you withdrew yourself or your professor withdrew or dropped you and you want to be reinstated in class then the professor will receive your reinstatement request and only the professor can give approval for readmission to class. You will be required to pay within 24 hours.
Dropped for Not Paying or Other Reasons
If you were dropped for other reasons, such as non-pay then the Admission and Registrar’s office will assist you with a reinstatement request once you complete the electronic reinstatement form, but you will be required to pay within 24 hours if approved.
If you were dropped for non-pay because you did not complete your financial aid submission requirements you will not be reinstated. See an advisor for offerings in a later starting session or term. Professors cannot and will not accept reinstatement requests if you were dropped for non-pay.