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Prospect Student Athlete Information

First Name: *

Last Name: *

Middle Name:

Preferred Name:

Date of Birth: *

Age:

Address: *

City: *

State:

Zip:

Home Phone: *

Cell Phone:

E-mail: *

SSU Alumni you know personally:

Parent/Guardian Contact Information

First Name: *

First Name: *

Last Name: *

Last Name: *

Cell Phone:

Cell Phone:

Work Phone:

Work Phone:

Email:

Email:

Brothers and Sisters (Names and Ages):

Parent/Guardian Contact Information

First Name: *

Relationship: *

Last Name: *

Home Phone:

Relationship: *

Phone: *

College Name:

Mobile Phone:

Occupation:

Email:

Employer:

College Name:

Phone: *

Ext:

Occupation:

Employer:

Work Phone:

Ext:

NCAA Academic Information

High School/Previous College Name:

Graduation Date: *

School Address :

District: *

School City:

School State:

School Zip:

Coach's Name:

Guidance Counselor's Name:

Email:

Home Phone:

Home Phone:

Office Phone:

Office Phone:

Cell Phone:

Cell Phone:

GPA: *

ACT:

SAT:

Date To Be Test (If not already taken):

NCAA Eligibility Center ID #:

If Junior College player, were you a qualifier?:

Additional Previous Colleges:

SSU Potential Majors

College of Business Administration:

College of Education:

College of Liberal Arts and Social Sciences:

College of Sciences and Technology:

SSU Potential Minors

College of Business Administration:

College of Liberal Arts and Social Sciences:

College of Sciences and Technology:

Athletic Information

Height: *

ft.in.

Weight: *

Uniform No.:

Bats:

Throws:

Positions:

Other Varsity Letters Earned(sports):

Summer Coach Name:

Summer Team :

Summer Coach E-mail:

Summer Coach Phone: