Urban Scholars Applicant Personal Profile Form
Name of Candidate:
Preferred or Nickname:
Gender:
Female
Male
Mailing Address:
Telephone Number:
Cell Phone Number:
Best day to call:
Best times to call:
Email Address:
Date of Birth:
Place of Birth:
Ohio Resident:
Yes
No
High School Name::
Type of School::
Public
Private
Parents/Guardians:
Address:
(If different from above)
Telephone:
Best days and times to call:
Email:
Majors or Careers:
Please list the majors or careers that you are considering. (You may list one or more interests or "undecided.")
Activities- Please list the activities you have been involved in, the position you held and grades in which you participated in this activity.
Example: Student Council Treasurer:
For example: Student Council Treasurer, in grades 10,11,12
Community Activities:
Indicate the activities and grades in which you participated in this activity.
Athletic Activities:
Indicate the activities and grades in which you participated in this activity.
School Activities:
Indicate the activities and grades in which you participated in this activity.
Honors Received:
List the honors you have received during high school and the grades in which you received the honor.
Hobbies/Special Interests:
Employment (Company, Position):
Participation in School-Related Conferences:
