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Online Request

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Online Information Request Form
Last Name:
First Name:
Middle Initial:
Email Address:
Street Address:
State:      Zip Code:
SSN: *
Date of Birth: *
*Either a social security number or a birthdate needs to be supplied in order to be added to the mailing list.
Sex: (optional)Female     Male
Name of High School/GED:
Enter entire School Name above, abbreviating individual words if necessary.
Do not include City unless it is a part of the name.
High School/GED State:      Year Graduated:

Planned School of Study
Planned Major/Program of Study:
Planned Enrollment in College:Fall     Summer     Spring
Campus Planned to Attend: Toledo Campus     Findlay Campus
Planned Year:

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