If you prefer to complete a paper application, please click here to download the forms, rules, and eligibility.

All fields must be completed prior to submission.
Please direct all questions to Deb Goins, Director via email or by calling 740-568-1926.

First Name:   Middle Name: Last Name:

Date of Birth(mm/dd/yyyy):

Shirt Size:

Ethnic Identity:

Gender:   U.S. Citizen:

Mailing Address:
Street:  City: State:  ZIP:

Home Telephone Number:   Email:

Cell Phone:   May we contact you via text?

High School:  Expected Graduation Year:
*Guidance counselors must provide recommendation and current transcripts

Current Year Federal Taxable Income: Number in Family:
*Will be required to provide tax documentation verifying taxable income and family size

Mother's Highest Education Level:

Father's Highest Education Level: 

Does the student currently participate in Educational Talent Search?

Optional: I authorize the use of my child's picture in UB newsletters, publications, & publicity:

Important:By electronically signing this application below, I agree that the information given is accurate.
I understand that misrepresentation of the facts on this application will be cause for refusal of admission,
cancellation of admission, or suspension from the program.

By electronically signing this application below, I agree to abide by the policies and regulations of the program.

Entering your name in the box below becomes your electronic signature acknowledging your agreement with the above terms:
Student Signature:    
Parent/Guardian Signature: