Address

City   State   Zip

Home Phone   Cell Phone   E-mail Address

Course Interests

Intended Major (if known)

Have you ever attended The Ohio State University before? Yes  No

Have you ever attended another college or university? Yes No (If yes, please be prepared to provide an official transcript of your previous college coursework.)

Quarter and Year of intended enrollment: AutumnWinterSpring Summer   2009 2010 2011 2012

Name of High School   What year did you graduate from high school or earn your GED?

Please indicate any additional information you would like to receive:
information on Ohio State Lima
a Lima campus class schedule
a Putnam County Center Schedule
information on specific major programs  Which one(s)?
financial aid information
other