Complete Intent to Enroll Response Form online or mail to Office of Admissions Kentucky State University 400 E. Main St. Frankfort, KY 40601

_ I intend to enroll at Kentucky State University in □ Spring □ Fall Semester _____ Year

Spring Fall Semester ___ Year

I do not intend to enroll at Kentucky State University in □ Spring □ Fall Semester _____ Year

Spring Fall Semester ___ Year

Campus Wide ID # (see acceptance letter):

Print Name (Last, First, Middle)

Home Address (number and street)

City

State

Zip Code

Mailing Address, if different from above (number and street)

City

State

Zip Code

Home telephone (with area code): _____

Cell phone (with area code): _____

Email address: ___

Alternate email address:

The quick brown fox jumps over the lazy dog.

Signature Date

12/21/2016