Continuing and Community Education KICK Registration
Full First Name
*
Do you have a middle name?
*
Yes
No
Middle Name
*
Last Name
*
Full Legal Name
*
Parent or Guardian
*
First Name
Last Name
Parent or Guardian Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Non-binary
Prefer not to disclose
Email
*
example@example.com
Hispanic or Latino Ethnicity
*
Yes
No
Race (Select all that apply)
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American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
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Highest Diploma/Degree Earned
*
None
High School
GED
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Certificate
Associate Degree
Bachelor’s Degree
Master’s Degree
Professional
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Other
Choose classes here
If you would like to be added to our KICK program email list please click here and you will be notified when the Summer 2025 schedule is posted
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