FCAP Application | Student & Community Engagement at Adelphi

Priority deadline to apply is August 1, 2025.

Name(Required)

First Last

Adelphi Email(Required)

Secondary Email

Mobile Phone

Student ID(Required)

Not sure of your student ID? You can look up your Adelphi ID number.

Age

Gender

This is optional

Allergies

Allergies to Medications

Emergency Contact

Name

First Last

Relationship

Phone

Insurance Information

Insurance Company(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Policyholder's Name(Required)

First Last

Do you need any special accommodations?(Required)

No

Yes

Provide details

Do you have any dietary restrictions?(Required)

No

Yes

Your Dietary Restrictions

I will be a(Required)

Commuter

Resident

Would you like to take advantage of early move in August?(Required)

Yes

No

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Name

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