OHIO NORTHERN UNIVERSITY
Tuition Exchange Certification Application Form 2015-16
I.
Personal Data
1. Student’s Name
Last 4 digits of SS#
2. Email Address
3. Permanent Address
4. High School
Graduation Date
5. Intended Major Program of Study
6. Parent's Name
Telephone
7. Parent’s Email Address
II. Academic Achievement Record
1. ACT Composite/SAT Total scores*
Test Date
*must be included on official high school transcript
2. a. High School GPA
b. High School Class Rank
3.
College GPA (if applicable)
4. Please list, with brief explanation if appropriate, awards/special distinction recognition for
academic performance:
III. Special Talents - Areas include, but are not limited to: Musical, dramatic, artistic, or athletic
talent, and distinctive creative accomplishment in a traditional academic area.
Please list and have available, upon request, copies of awards, prizes, portfolios,
publications, letters of commendation:
Tuition Exchange Certification Application Form 2015-16
IV. Leadership and Service to Others - Areas include, but are not limited to: Participation in
high school, community, religious and/or other organizations and awards/special distinction
for leadership and service areas. (Please do not repeat any items from Sections II and III
above).
Please list and have available, upon request, copies, as appropriate for documentation:
V. Member institutions of Tuition Exchange to which you are applying:
Before continuing, please Print and sign this document.
VI. I certify that all of the above information is correct. The Tuition Exchange Selection
Committee may seek additional verification.
Signature of Applicant
Date
Signature of Parent
Date
Parental signature affirms applicant is a dependent eligible under University policy for tuition
remission status and hence eligible for Tuition Exchange certification by ONU.
Please return this application, official high school transcript, and, if appropriate, college
transcripts, with accompanying ACT/SAT score reports by November 2, 2015 to:
Tammy Everhart, Academic Affairs, Ext. 2033
Application forms received after November 2 will not be included in the initial candidate review
but are acted upon if available spaces are not filled by the initial candidate pool.