Please select which campus would you like to submit your application to:

 Last Name:

First Name:

Address:

City:

State:

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Phone:

Email Address:

High School Attended:

Graduation Date:

My High School GPA (approximately):

My intended program of study in college is:

I studied classes/attended academy classes in high school in this field of study:

I (type name here) would like to apply for the Keiser University Career Academy Scholarship