Name Age Sex Date of Birth mm/dd/yyyy
I am interested in attending:
Shawnee State University
The Ohio State University
Ohio University
None of the above
My high school grade point average is: 4.0 3.6 - 3.99 3.0 - 3.59 below 3.0
I will be applying for the following scholarships: (Check all that apply) Academic Athletic Community None
In the box below, list all extra-curricular activities in which you were involved in grades 9 - 12:
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