Kentucky State University | CLUB KYSU: Personal Finance Enrollment Form

CLUB KYSU: Personal Finance Enrollment Form

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First Name*

Last Name*

Birthdate*

Age*

Gender*

Grade*

Race

African American

Asian American

Caucasian

Hawaii Native or Pacific Islander

Native American or Alaska Native

Ethnicity

Hispanic

Non-Hispanic

Student's Email Address

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian's Email Address*

Mailing Address*

Street Address

Address Line 2

City*

State*

Zip/Postal Code*

County*

Indicate what email address to use for participation in online program*