Bursar's Office Graduate Office Graduate Office/KU Card (Student ID)
Graduate School Application Processing
and The KU Card (Student ID) Fee		 Graduate School Application Processing
and The KU Card (Student ID) Fee		 Graduate School Application Processing
and The KU Card (Student ID) Fee
(Please Print)
 (Please Print)
 (Please Print)
NAME______________________________________________ NAME______________________________________________ NAME______________________________________________
            last                        first                             middle                   last                          first                   middle           last                                   first                        middle
     
ADDRESS ___________________________________________
 ADDRESS ___________________________________________ ADDRESS ___________________________________________
______________________________________
 _______________________________________ ______________________________________
______________________________________ _______________________________________ ______________________________________
    city                                                    state                 zip      city                                                        state              zip     city                                                      state               zip
FIRST TIME APPLICANTS pay a $35.00 non-refundable fee.
Please remit $35.00 by check __________ or
money order ____________  payable to Kutztown University		 FIRST TIME APPLICANTS pay a $35.00 non-refundable fee. FIRST TIME APPLICANTS pay a $35.00 non-refundable fee.

Please Note:  This document will need to be printed out as Landscape in your printer setting.