EDUCATION OUTREACH PROGRAMS AT OSU LIMA

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Thank you for your interest in the OSU Lima's Education Outreach Programs
If you prefer to send your proposal by regular mail, please print a copy of this page
and mail it directly to Sara Newman OSU Lima, 4240 Campus Drive, Lima OH 45804

Name:
School/organization
Grade level/age group
Address:
City:	State: Zip:
E-Mail:
Phone:

Select one of the programs below:

Program: Number of students
	Date 1st Choice
	Date 2nd Choice
	Date 3rd Choice
Time

Additional comments, maximum 100 words

Last Modified on 01/25/2008

© 2007, The Ohio State University.
If you have trouble accessing this page and need to request an alternate format, contact webmaster@lima.ohio-state.edu
The Ohio State University at Lima, 4240 Campus Drive, Lima, Ohio, 45804 Phone: 419.995.8391

Name:

School/organization

Grade level/age group

Address:

City:

State: Zip:

E-Mail:

Phone:

Program:

Number of students

Date 1st Choice

Date 2nd Choice

Date 3rd Choice

Time

Additional comments, maximum 100 words

Name:

School/organization

Grade level/age group

Address:

City:

State: OH AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY Zip:

E-Mail:

Phone:

Program:

Number of students

Date 1st Choice

Date 2nd Choice

Date 3rd Choice

Time

Additional comments, maximum 100 words

State: Zip: