Name DOB SS#

Address Phone #

City State Zip

Email

Parent or Guardian Name(s)

Parent or Guardian Occupation(s)

High School Graduation Date

High School Address

HS Phone HS GPA HS Code

ACT Scores: English Math Reading Science Reasoning

ACT Composite and/or SAT Scores: Verbal Math

SAT Composite

High School Coach

HS Coach's Home Phone # School Phone #

Years on Varsity Team Position(s) Played

Honors/Awards (academic or athletic)

Team Name Years on Team

Club Coach Phone #

Position(s) Played

Honors/Awards

Junior College Graduation Date

JC Address JC GPA

JC Coach JC Coach Phone #

JC Position Played

Honors/Awards (athletic or academic)

What schools are you interested in attending?

What do you intend to major in at college?

Do you have an application?

Would you be interested in finding out about Financial Aid opportunities?