Name and Contact Information

First Name

Last Name

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Street Address

City

State or Province

Country

Zip/Postal Code

Program Information

Anticipated Start Term

Anticipated Start Year

Student Type/Admissions Category

What Major would Pursue here at KSU?

How many guests will accompany the student?

Do you plan to attend the basketball game?

Optional Information

Birthdate (mm/dd/yyyy)

Gender

Home Phone

Mobile Phone

Are you Hispanic?

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