Kentucky Council on Postsecondary Education
2014 Academically Proficient High School Junior and Senior Diversity Conference

 
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1. Student first name:
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2. Student last name:
3. Street address:
4. City:
5. State:
6. Zip code:
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7. Phone number (with area code):
8. Gender:
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9. Student email address:
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10. School:
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11. Classification (as of Fall 2014):
12. What is your future major/area of interest?
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13. Parent(s)/Guardian(s) names:
14. Parent(s)/Guardian(s) work phone:
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15. Will your parent(s) or guardian(s) attend the conference with you?
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16. Do you plan on requesting overnight lodging at Murray State University? (If yes, please complete the Housing Form listed on the main conference page.)
17. If the student or parent(s)/guardian(s) need special accommodations (I.e. handicapped accessible rooms or vegetarian meals) during the conference, please specify below.
18. Will the student or the parent(s)/guardian(s) need transportation to the conference? (Transportation will be arranged on a limited basis.)
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