| Todays Date* |
( mm / dd / yyyy ) |
| Preferred time of visit |
|
| First Name* |
|
| Last Name* |
|
| Address* |
|
|
City* |
State* |
Zip* |
| Phone (home) |
(include area code) |
| Phone (cell) |
(include area code) |
| Email Address |
|
| High School |
|
| Grade Level |
|
| Ethnicity |
|
Have you applied for admission
to the University of Cincinnati? |
Yes
No |
| Parent(s) Name |
|
Your Availability
Under each day, indicate the time you are available. (Shadow schedules
vary and are based on availibility of nursing students.) |