Former Student Inquiry Form

Welcome back to Ohio Christian University!

Please fill out the following information:

First Name *

Middle Name

Last Name *

Has your name changed since you last attended Ohio Christian University? *

Yes

No

Former Last Name *

Which program did you previously attend at Ohio Christian University?

Preferred Format (Check all that apply)

Trailblazer Academy - High School Campus

Trailblazer Academy - Main Campus

Trailblazer Academy - Online

Contact Information:

Personal Email Address *

Phone Number *

May we text you at this number?

Yes

No

Birthdate *

Mailing Address *

Country

Street

City

Region

Postal Code

Dual Enrollment for High School Students

Term of Interest

Please list any former Colleges attended:

Previous Institution 1 - Name

Previous Institution 1 - Start Date (Year):

Previous Institution 1 - End Date (Year)

Previous Institution 1 - Degree Attained

Previous Institution 2 - Name

Previous Institution 2 - Start Date (Year):

Previous Institution 2 - End Date (Year)

Previous Institution 2 - Degree Attained

Previous Institution 3 - Name

Previous Institution 3 - Start Date (Year):

Previous Institution 3 - End Date (Year)

Previous Institution 3 - Degree Attained

Please list two references:

Relationship 1 - Relationship Type

Relationship 1 - Relationship Type "Other" Explanation

Relationship 1 - First Name

Relationship 1 - Last Name

Relationship 1 - Email

Relationship 1 - Phone Number

Relationship 2 - Relationship Type

Relationship 2- Relationship Type "Other" Explanation

Relationship 2 - First Name

Relationship 2 - Last Name

Relationship 2- Email

Relationship 2- Phone Number

Would you like to enter a Parent or Guardian's contact information?

Yes

No

Parent / Guardian - First Name

Parent / Guardian - Last Name

Parent / Guardian - Email

Parent / Guardian - Phone

Parent / Guardian - Address (Street)

Parent / Guardian - Address (City)

Parent / Guardian - Address (State)

Parent / Guardian - Address (Zip Code)

Confirmation

*I understand that since my time away from Ohio Christian University, there may have been program or catalog requirement changes that could affect my degree completion time.

This application and all supporting documents become the property of Ohio Christian University and will not be returned to you or forwarded to another institution. I understand Ohio Christian University will report grades and appropriate information to my high school counselor.

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Former Student Inquiry Form