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. When using Polk State’s electronic forms through Etrieve for the first time, you will need to perform a password reset by providing your institutional email. Once your password is reset, your Etrieve Username to login is the first part of your institutional email ( i.e. firstname.lastname@example.org would be marysmith22). Paper forms that can be faxed are noted below. The fax number is 863.297.1023. 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 Admission and Registrar’s Office by calling 863.297.1000 or coming to any campus or center’s Admission and Registrar’s office. You may also see a Disability Service Advisor on the Lakeland or Winter Haven campus.
You can submit the Residency Declaration as an electronic form through our Etrieve system. When using Polk State’s electronic forms through Etrieve for the first time, you will need to perform a password reset by providing your institutional email. Once your password is reset, your Etrieve Username to login is the first part of your institutional email ( i.e. email@example.com would be marysmith22).
Copies of all documentation must accompany the Residency Declaration. For further details on residency requirements, go to FloridaShines.org/Residency 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.
- 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.
- Provided to students one week after drop deadline.
- Available 24/7 through National Student Clearinghouse.
- When the National Student Clearinghouse website opens, select the “Verify Current Enrollment” link.
OUTGOING TRANSIENT FORM
Most outgoing transient forms are done online through FloridaShines.org. 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 FloridaShines.org electronic transient form. If your institution does not use the FloridaShines.org 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 FloridaShines.org electronic incoming transient form.
CHANGE OF NAME, SS#, DOB, CITIZENSHIP AND OTHER
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. Submit these forms in person only with related proof.
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.
FERPA RELEASE OF INFORMATION – STUDENT
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.
OPTING-OUT OF DISCLOSURE OF INFORMATION
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.
REQUEST FOR GED CREDENTIALS
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 firstname.lastname@example.org. 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.
HIGH SCHOOL TRANSCRIPT REQUEST
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 TUITION WAIVER REQUEST
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 TEACHER WAIVER REQUEST
Classroom teachers may qualify for a tuition waiver for certain classes. For more information go to the State Employee and Classroom Teacher Information Page
REINSTATEMENT TO CLASS
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.