Kansas State University

Name *
Address *
City * State * Zip *
Phone Number *
Email Address *

High School Name
High School Graduation Date (Month/Year)
Expected Date of Entry (Month/Year)
College (if transfer student)

Aviation Maintenance Professional Pilot Construction Engineering Technology Computer Systems Technology Electronic & Computer Engineering Technology Mechanical Engineering Technology Web Development Technology Applied Business Applied Science Technology Management Major of Interest

Preferred Date of Visit (Month/Date/Year) *

Preferred Time of Visit *

Special Needs or Comments

* Required