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KIIS Lifelong Learners in Italy - "The Worlds of Michelangelo" - May 2020
Please complete one form per person.
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PARTICIPANT ENROLLMENT INFORMATION
KIIS Lifelong Learners in Italy Participants are admitted in the order in which their enrollment form and $500 nonrefundable deposit are received until the maximum group size of 16 participants is reached. Program payments may be made by check or money order. Donations to the KIIS Student Scholarship Fund also welcome! Visit the KIIS Lifelong Learner program webpage for program and payment details:
https://www.kiis.org/programs/lifelong-learners-in-italy/
.
For questions, contact Prof. Chris Fulton at
cfulton@louisville.edu
or the KIIS staff webpage:
https://www.kiis.org/about-kiis/contact-us/kiis-office/
.
PARTICIPANT INFORMATION
Participant Email
Your answer
Title
Choose
Mr.
Ms.
Miss
Mrs.
Prof.
Dr.
Rev.
Last Name
Your answer
First Name
Your answer
Middle Name
Your answer
Gender
Your answer
Date of Birth (mm/dd/yyyy)
Your answer
Mailing Address (Street, City, State, Zip)
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
ACCOMMODATIONS
Housing Preference
Choose
Double Occupancy
Single Occupancy (add $2000)
I am applying with a family member / friend. We wish to room together with
Choose
One Double Bed
Two Single Beds
If applicable, please write the name of your desired roommate.
Your answer
Do you have any specific needs (dietary, health/medical, fitness, etc.)? Please specify.
Your answer
Are there any other important factors in your housing or travel arrangements? Please specify.
Your answer
ADDITIONAL QUESTIONS
Are you a KIIS Alumni?
Choose
Yes
No
If a KIIS alumni, what year and on what program did you study or teach with KIIS?
Your answer
How did you hear about the KIIS Lifelong Learner program in Italy?
Your answer
COMMENTS OR QUESTIONS
Do you have any questions or items you wish to share related to the KIIS Lifelong Learners in Italy 2020 program?
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