Address 

City    State    Zip 

Daytime Phone 

Evening 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:  Autumn Winter Spring Summer   2007 2008 2009  

Name of High School

Please indicate any additional information you would like to receive:

information on Ohio State Lima

a Lima campus class schedule

a Bellefontaine Center schedule

a Putnam County Center Schedule

information on specific major programs 
Which one(s)? 

financial aid information

other