Prospective Student-Athlete Questionnaire

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Telephone

Email

Gender Male Female

Address

Address 2

City

State

Zip

Student Status High School Junior College

School Name

Address

City

State

Zip

Telephone (starting with area code)

Expected Date of Graduation (mm/dd/yyyy)

Anticipated Entrance Status (Select all that apply) Freshman International Student

Transfer Year Year Sophmore Junior Senior

ACT Scores

SAT Critical Reading Score

SAT Writing Score

SAT Math Score

Class Rank

Grade Point Average

Intended Major

Have you registered with the NCAA Clearinghouse? Yes No

Have you registered with the Amateur Clearinghouse? Yes No

Sport(s) please check all that apply

Please list any additional information about yourself that is relevant and athletic honors you have received.