Kent Blossom Art!
Application for Admission
Summer 2009

Submit slides or CD with images following instructions posted on the website.

Student Information

First Name:	Middle Initial:	Last Name:

Date of Birth:	Last Four Digits of Soc. Sec.:
/ /
Banner ID:	Ethnicity:

Gender?	Female Male
US citizen?	Yes No
if no, Country of Citizenship:
Country of Birth:
Native Language:
If permanent resident, PR#:
Visa Status:

Are you an Ohio Resident?	Yes No
County:
Will you require on-campus housing?	Yes No

Local Address

Permanent Address

Emergency Information

Parent (or someone to call in case of an emergency):

Street Address:

City:	State:	Zip:

Phone Number:

Education Information

Student Status:	Ever attend KSU before?	Current KSU Student?
	Yes No	Yes No
If you have attended KSU before, give date & campus attended:
From	To	Campus
(yyyy)	(yyyy)

If not already enrolled at KSU, have you applied for summer admittance? (For graduate credit, you must apply to the Graduate School for summer 2009.)
Yes No

Have you participated in the Blossom Arts Program before? Yes No

Please provide information on post-secondary (college) education:
Degree	Granting Institution

Date	Major
(yyyy)

If in a graduate program now, give school name:
Degree	Institution

Studio Area

Have you ever been convicted of a criminal offense or have charges pending against you at this time? (other than minor traffic violations)

Yes No

Have you ever been dismissed, suspended or placed on probation by any other college or university for a a non-academic reason?

Yes No

Kent Blossom 2009 Program Selection

Please indicate the program(s) you would like to apply for and an alternate if you have one. If you are not admitted in the area of first choice, your credentials will be reviewed for your second choice.

Cost of workshops:	3 Undergraduate Credits: $1152
	3 Graduate Credits: $1224

Program Choice 1:
Alternate 1:

Program Choice 2:
Alternate 2:

Personal Statement

Type or paste in your personal statement of up to 750 words here:

Kent Blossom Art!Application for Admission Summer 2009