Name:  
Address:  
City: State: Zip Code:
Country (if not USA)
Home Phone: Cell Phone:  
E-Mail  

Home Country: If not USA, Do you have a Green Card?

What is your date of birth? (month/day/year)

What is your father's name? Father's Cell Phone

What is your mother's name? Mother's Cell Phone

Your High School's Name:
Your High School's Address:
Your High School's City Your High School's State
Your High School's ZipCode Country (if not USA)
Your High School's Phone

Cross Country Coach's Name Phone
Cross Country Coach's E-mail
CC Personal Record Distance Time Meet

Track Coach's Name Coach's Phone
Coach's E-Mail
Track Personal Record(s) Event Time/Distance
Event Time/Distance
Event Time/Distance
Event Time/Distance

All cross country and track times/distances will require official verification before athlete is considered for any athletic scholarships.
Guidance Counselor's Name Phone
Guidance Counselor's E-Mail
Date of High School Graduation or GED (Month/Day/Year)
Final High School GPA (OK to estimate)
Enter "yes" to verify that this information is correct