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Personal Information

Legal First Name

Middle Name

Legal Last Name

Suffix

Date of Birth * MM/DD/YYYY

Are you a First Generation college student? *
You're a "first-generation" college student if neither of your parents has a bachelor's degree or if before turning 18, you didn't live with or receive support from either of your parents.

YesNo

Contact Information

Email Address *

Do NOT use an @icloud.com email address; iCloud/Apple is NOT compatible with this application system.

Do NOT use your High School email address as it is temporary and you may lose ability to reset your password on your own.

Confirm Email Address *

Do NOT use an @icloud.com email address; iCloud/Apple is NOT compatible with this application system.

Do NOT use your High School email address as it is temporary and you may lose ability to reset your password on your own.

Preferred Phone Type

Current Address

Is this address outside of the U.S.A., Canada, or the Freely Associated States?YesNo

Street Address (Line 1)
Do NOT enter a P.O. Box.

Street Address (Line 2 - optional)
Do NOT enter a P.O. Box.

City

State/Province

ZIP/Postal Code

Country

Academic Interest

Location of Preference

Some programs are not available at all KCKCC locations. However, your preference is still important to us and may provide opportunities to update program locations for future students.

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Personal Information

Contact Information

Current Address

Academic Interest

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