Program Application

Continuing Education at Kennesaw State University

Program Application

Red indicates a required field.
First Name:		Middle Initial:
Last Name:		Date of Birth (mm/dd/yyyy):
Address:
City:		State:
Zip Code:		Email:
Telephone:		Secondary phone:
	Male Female	*SSN

* Social Security Number is optional for 1098T tax purposes.

Have you graduated from high school or received a GED?

Yes

What year?

* Many of our certificate programs require a High School Diploma or equivalency. Please check program prerequisites for entry requirements.

What programs are you interested in (check all that apply)?

	Medical Billing & Coding Specialist		Administrative Professional
	Medical Interpreter	Pharmacy Technician	Culinary Apprenticeship
Lifestyle & Weight Management Coach			Meeting & Event Management

Please use the space below to write a short paragraph explaining your interest in the program you have chosen.

How did you hear about this program?

Catalog	Website	Friend
Flyer	Newspaper	Training Expo/Information Session
Postcard	Email	Other (specify):

All applicants will be notified via email regarding the status of their Program Application. Please allow up to 5 business days for a response. Acceptance into a program does not automatically reserve your spot; you may be required to provide additional documentation prior to registration.