Family name: First and middle names:

Gender Citizenship:

SEVIS ID:

KSU Student ID:

KSU email: Personal email:

Marital Status: ___ Single ___ Married ___ Other

I am ___New student ___Transfer student ___KSU student changing academic level

Academic level to study at KSU ___Associate ___Bachelors ___Master's ___DNP

U.S. Address (it can be temporary address) Home Country address

Home Country address

US Phone:

Home Country Phone:

Emergency Contact Information

In the U.S. (unknown, can leave blank)

In Your Home Country

Name:

Name:

Street and/or Apt #:

Relationship:

Phone:

City and State and zip code

Relationship:

Phone:

Email:

Dependents CURRENTLY With You in the U.S.:

Email: