Personal Information

Name:
E-MAIL Address:
Street Address:
City: State: ZIP:
Home phone: Date of birth(mm/dd/yy):  Age:
Height:   Weight:
Parent's name(s):

Scholastic Information

School Currently Attending:  
High School Junior College 4 year College/UniversityHigh School
Classification: 5A   4A   3A   2A   1A  Private
Date of your graduation:
Grade point average:   Class rank:
ACT:   SAT:
Intended Major:

Athletic Information

Coach: Coach's phone:
Places in district, regional, state:
List your best times:
Cross Country Honors:
Explain any injury incurred:
Other sports in which you compete:

Have you registered with the NCAA Initial-Eligibility Clearinghouse?
Yes No

If NO, contact your guidance counselor, who can obtain materials, at no cost, by calling the Clearinghouse at 319-337-1492. Registration with the NCAA Clearinghouse can also be done at www.ncaaclearinghouse.net. Also, when taking the SAT and ACT, scores can be sent to the clearinghouse by putting the clearinghouse's institution code "9999" in the box when registering to take the tests.