Please print or type

Send the application to: Aquaculture Graduate Coordinator, Aquaculture Research Center, Kentucky State University, Frankfort, Kentucky 40601

1. Social Security Number:__________________________________________________

2. ______________________________________________________________________

Last Name / First Name / Middle Name

 
3. Other last name(s), if any, which may appear on transcripts:

______________________________________________________________________
 

4. Home Address:_________________________________________________________
 

______________________________________________________________________

City / State / Zip
 

5. Mailing Address (if different from above):________________________________________________________

______________________________________________________________________

City / State / Zip
 

6. Telephone Numbers: Home (____) ___________________ Office (____) ____________________________

7. Birth Date: _____/_____/_____ 8. Gender (reporting purposes only): _____ Male _____ Female

9. Citizen of United States:

_____ Yes

_____ No

If No, of what country are you a citizen?:_______________________________________________

If No, are you a permanent resident of the US?:__________________________________________

Resident Alien Number:_____________________________________________________________

Type of VISA:__________________________ Expiration Date:___________________________

10. Ethnic Group (for reporting purpose only):

_____ Black _____ White _____ American Indian

_____ Hispanic _____ Asian or Pacific Islander _____ Other

11. Undergrade Degree Information

Please list all colleges and universities attended
 

SCHOOL	CITY AND STATE	DEGREE (IF ANY)	DATE AWARDED	DATES OF ATTENDANCE

I understand that I am to have each institution (other than Kentucky State University) that I have attended as a graduate or undergraduate student send a transcript of my record directly to the Aquaculture Research Center at Kentucky State University.

12. Have you taken the GRE? _____ Yes _____ No  If yes, when taken? _____/_____/_____

If yes, sent to KSU? _____ Yes _____ No

13. For which one of the following admission categories are you applying?

_____ Degree Seeking Student -- interested in a KSU Master’s degree

_____ Non-degree Student -- currently not interested in a degree from KSU

_____ Visiting Student -- pursuing an advanced degree at another institution

I understand that withholding information on this application or giving false information will make me ineligible for admission. With this in mind, I certify that the above statements are true and correct.

THIS FORM MUST BE ACCOMPANIED BY A NON-REFUNDABLE $15.00 APPLICATION FEE.

Please make the check or money order payable to Kentucky State University.

Date of application__________________________

Signature___________________________________________________________

(Do not print)

APPLICATION MUST BE ACCOMPANIED BY A NON-REFUNDABLE $15.00 APPLICATION FEE.

Please make check or money order payable to Kentucky State University. If mailing this application, do not send cash through the mail.

The listing below provides telephone numbers for Kentucky State University offices the prospective student may need to contact. The area code for KSU is 502.

 
 

Academic Affairs Bookstore Cashier Financial Aid Health Services Record and Registration

227-6442 227-6353 227-6250 227-5960 227-6271 227-6340

Aquaculture Graduate Coordinator  Division of Mathematics and Sciences Student Housing Student Affairs Student Health Insurance

564-9103   227-6603 227-6671 227-6671 227-6671

 

*The applicant who has not yet completed the undergraduate degree should have forwarded one transcript now and one after the degree is completed. International students must also submit certified English translations of each international transcript submitted.

**The Graduate Record Examination (GRE) must have been taken within the past 5 years at the time of the application. Applications to take the GRE may be obtained from the Educational Testing Service, P. O. Box 6000, Princeton, New Jersey 08541-6000 or by phone at 609-771-7670 or 510-654-1200. It is the responsibility of the applicant to apply for and take the examination and to have the official scores sent to the Aquaculture Graduate Coordinator, Aquaculture Research Center, Kentucky State University, Frankfort, Kentucky 40601.

It is the policy of Kentucky State University not to discriminate against any individual in its educational program, activities, or employment on the basis of race, color, national origin, sex, disability, veteran status, age, religion, or marital status.

Please do not write below this line: 

Term: ___________________

Paid:____________________

Receipt #:________________

SIS/Date:_________________

LRec 1:__________________

LRec 2:__________________

LRec 3:__________________

Admit Code:_______________

Advisor:__________________