Young Scholar Registration Form

Have you taken young scholar classes at King's College before?

Yes

No

King's College ID Number (if known)

PERSONAL BACKGROUND

First Name - please DO NOT use any nicknames

Preferred Name (if different than legal)

Last Name

Birthdate

Gender

Female

Male

Phone type

Home Phone

Mobile Phone

Phone number

Social Security Number

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Confirm Email Address

Current School

Guidance Counselor Name

Guidance Counselor Email

Guidance Counselor Phone Number

Graduation Year

Are you Hispanic or Latino?

Yes

No

What is your racial background? (please select all that apply)

COURSE SELECTION

What term do you wish to take class(es)?

Please list the course(s) you wish to take this semester as well as alternate course(s). In the event that we cannot register you for your first choice, we will try to register you for your alternate choice(s). Thank you.

Example:

Course Number & Title	Section	Days	Time
BUS 363 - Operations Management	E	Th	6:00-8:30 PM
Alternate Courses
ACCT 410 - Auditing	B	T, Th	12:30-1:45 PM
ARTS 103 - The Art of Improvisation	A	M, W, F	1:25-2:15 PM

1. Course Number and Title

Section

Days

Time

2. Course Number and Title

Section

Days

Time

Please list up to three (3) alternates.

1. Alternative Course Number and Title

Alternative Section

Alternative Days

Alternative Time

2. Alternative Course Number and Title

Alternative Section

Alternative Days

Alternative Time

3. Alternative Course Number and Title

Alternative Section

Alternative Days

Alternative Time