Form Dnr 8803 - Student Registration Form - Ohio Department Of Natural Resources, Division Of Wildlife

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STUDENT REGISTRATION FORM
OHIO DEPARTMENT OF NATURAL RESOURCES • DIVISION OF WILDLIFE
Customer ID:
(if known) _____________________________________________________
First Name:
_________________________________________________ Middle Initial: _________________
Last Name:
______________________________________________________________________________
Address 1:
______________________________________________________________________________
Address 2:
______________________________________________________________________________
City:
____________________________________________ State: _____________________________
Postal Code:
______________________________________________________________________________
Phone Number: ______________________________________________________________________________
Email:
______________________________________________________________________________
County:
____________________________________________________________ __________________
Birth Date:
(mm/dd/yyyy) ______________________________ Last 4 digits of SSN: _____________________
Your voluntary completion of this section will help the Division of Wildlife in administering the statewide program to
assure that equal opportunity is provided to individuals without regard to their race, color, national origin, or handicap.
Gender:
_____________________________________ Race: ___________________________________
q
q
Does anyone in your family hunt/trap?
No
Yes
q
q
Are you taking the course so you can buy your first license?
No
Yes
q
q
Are you handicapped?
No
Yes
INSTRUCTOR USE ONLY
Completion Date: _______________________ Course Grade: ______________
Ohio Department of Natural Resources
DIVISION OF WILDLIFE
Outdoor Education
2045 Morse Road, Bldg. G
Columbus OH 43229-6693
1-800-WILDLIFE •
DNR 8803 (R1011)

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