Outreach Connection Card

Please indicate which best describes you.

Student

Educator

Parent or Guardian

Students First Name

Students Last Name

Student Email Address

Student Phone Number (ex. 19181234567)

Birthdate

Students Home Address

Country

Street

City

Region

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent Number (ex. 19181234567)

Educators First Name

Educator Last Name

Educator Email Address

Texting Allowed?

Yes

No

Do you teach junior high/middle school or high school?

Junior High/Middle School

High School

School Name

What native tribe are you a citizen of?

How did you hear about OSU-CHS?

4H

FFA

None

Project Lead the Way

Which of our programs are you interested in?

The 3+1 Program is designed for undergraduate students who want to become physicians and would like to accomplish this goal in seven years instead of eight. For more information, visit this link.

Yes

No