Information Request Form

Personal Information

Title: *

First name: *

Middle name:

Last name: *

Birthdate: *

Ethnic origin (optional):

Contact Information

Street address: *

City: *

State: *

Zip code: *

Country: *

Phone number: *

Email address: *

Academic Information

High school name: *

High school city:

High school state:

Graduation year: *

GPA:

Class rank:

Class size:

ACT Composite:

SAT Verbal:

SAT Math:

If transfer

From which college/university:

College GPA:

Have you participated in the Kentucky Governor's School for the Arts or the Governor's Scholars Program?:

Yes

Have you been recognized as a National Merit Semi-Finalist or Finalist?:

Semi-finalist

Finalist

Neither