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Ohio University Zanesville Campus Information Request Form

My name and background
First Name*
Middle Name
Last Name*
Nickname
Gender
I am a U.S. Citizen
I will apply for
I will apply as a
Ethnic Background - please select one or more races from the following**
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American
I am Hispanic/Latino**
Yes
No
My contact information
Address*
Address 2
City*
State*
Zip Code*
Country
Phone Number
E-Mail Address*
My high school
State
City
High School
My interests
My academic interests are
My other interests are

*

**

Required field

This information is optional and will not be used for discriminatory purposes.