personal profile form for Templeton Scholars at Ohio University

Office for Multicultural Student Access and Retention

Templeton Scholars Applicant Personal Profile Form

Name of Candidate:

Preferred or Nickname:

PID Number:

Telephone Number:

Cell Phone Number:

Best day to call:

Best times to call:

Email Address:

Mailing Address:

Date of Birth:

Place of Birth:

Gender:

Female

Male

Ohio Resident:

Yes

Parents/Guardians:

Address:

(If different from above)

Telephone:

Best days and times to call:

Email:

Please list the majors or careers that you are considering. (You may list one or more interests or "uncertain";)

Majors or Careers:

School, Community, and Athletic Activities

I. Please list, in order of importance to you, the three activities (school, community, sports, etc.) that you feel have been your most significant since the beginning of your freshman year.

Please indicate years of participation (freshman-1, sophomore-2, junior-3, senior-4) and comment on any major emphasis or achievement.

1. Activity and Years You Participated:

Office or Positions Held:

Comments:

2. Activity and Years You Participated:

Office or Positions Held:

Comments:

3. Activity and Years You Participated:

Office or Positions Held:

Comments:

II. School Activities: Please list, in order of significance to you, other school activities in which you have participated since the begining of your freshman year.

Activity/Position/Year:

III. Community Activities: Please list, in order of significance to you, other community activities in which you have participated since the begining of your freshman year.

Activity/Position/Year:

IV. Athletic Activities: Please list, all sports and other physical activities in which you have participated since the begining of your freshman year. (Please note whether school sports are varsity or non-varsity).

Activity/Position/Year:

Honors Received:

School-Related Conferences:

Hobbies/Special Interests:

Employment (Company, Position):

Additional Information: