Student Information Form Fields marked with an * are required First Name * Last Name * Email Address * Contact Number * Local Address Local Address Street * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Local Address Home Address (if different) Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Application Information Were you referred by someone? Are you applying for a specific department? Please put that here. Do you have a valid Driver's License? * Yes No When did you start driving? * Check all that apply * I am a U.S. Citizen I am a Full-Time Student I am a Part-Time Student I am an Undergraduate Student I am a Graduate Student I am a KY Transportation Cabinet Scholarship Recipient Expected Graduation Date * GPA * Please provide your current GPA. Were you previously employed by the University or another State Agency? * No Yes If so, please list department name(s) and dates of employment. Are you presently employed by the University or another State Agency? * No Yes If so, please list department name(s) and dates of employment. Please list any prior Engineering Work Experience (if any). When are you available to start? * Are you available to work summers? * Yes No Availability Please denote your class schedule and work availability. Monday * Tuesday * Wednesday * Thursday * Friday * If you are a human seeing this field, please leave it empty.
