First Name Middle Initial Last Name

Street Address City State Zip

Father/Guardian Occupation

Mother/Guardian Occupation

Age Date of Birth Graduation Date

Phone E-mail

Current School Phone

Street Address City State Zip

Counselor

Class Rank/Class Size ACT GPA

SAT Math SAT Verbal SAT Essay

Intended Major 1 Intended Major 2

Academic Honors

Hobbies/Interest

Clubs, Groups, Etc.

Position 1 Position 2

Height Weight

H.S. Coach Phone

Athletic Honors

Other Sports

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