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Templeton Scholars Program Application—Personal Profile Form

Name of Candidate:

Preferred or Nickname:

PID Number:

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

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:

4. Activity and Years You Participated:

Office or Positions Held:

Comments:

5. Activity and Years You Participated:

Office or Positions Held:

Comments:

6. Activity and Years You Participated:

Office or Positions Held:

Comments:

II. Honors and Awards:

III. Participation in School-Related Conference or Convention. (Governor’s Scholars, Boys/Girls State, etc.):

IV. Hobbies and Special Interests.:

V. Employment. (Company, Position):

Is there anything else you would like to add?:

Contact Information:

31 S. Court Street, Rm. 196 | Athens, Ohio 45701 | T: 740.593.9376 | F: 740.593.2920

diversity@ohio.edu

Ohio University Contact Information:

Ohio University