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