Prospective Athlete Questionnaire

( * = required field in form below)

Student's name: *

Student's email: *

Student's School Information

High school:

Graduation date (or GED date):

School's address

Street address:

City:

State:

Zip: *

Academic information:

GPA:

Class rank:

Academic interests:

Academic accomplishments:

Student's Personal Information

Street address: *

City: *

State:

Zip: *

Country:

Phone number:

Age:

Height:

Date of birth:

Father's name:

Mother's name:

Sport Specific Information

Sport:

Have you registered with the NCAA Clearinghouse?

Yes

When did you register?

High school coach:

Club team:

Club team coach:

Position Played:

Athletic accomplishments: