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Appalachian Scholars Program Application—Personal Profile Form

Which campus do you plan to attend?:

Athens

Chillicothe

Eastern

Southern

Zanesville

Request FAFSA:

Yes

Name of Candidate:

Preferred or Nickname:

Gender:

Female

Male

Mailing Address:

Student PID#:

Telephone Number:

Cell Phone Number:

Email Address:

High School Name:

Guidance Counselor Name:

Guidance Counselor Phone:

Guidance Counselor Fax:

Please list majors or careers you are considering:

Please list the honors you have received during high school and the grades in which you received the honor:

Please list any school related conferences or conventions (e.g. Buckeye Boys/Girls State) in which you participated:

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:

School Activities:

Extracurricular Activities:

Community Activities:

Please list Hobbies/Special Interests that you have:

Please list your employment history including both the organization name and your position:

Is there anything else you would like to add?:

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Appalachian Scholars Program Application—Personal Profile Form

Contact Information:

Ohio University Contact Information: