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Prospect Student Athlete Information

First Name: *

Last Name: *

Middle Name:

Preferred Name:

Date of Birth: *

Age:

Gender:

Address: *

City:

State:

Zip:

Home Phone: *

Cell Phone:

Email: *

SSU Alumni you know personally:

SSU ID #: *

Parent/Guardian Contact Information

First Name: *

Last Name: *

Cell Phone:

Work Phone:

Email:

Siblings (Names and Ages):

Parent/Guardian Contact Information

First Name: *

Last Name: *

Relationship: *

Phone: *

Cell Phone:

Email:

Summer Team:

Occupation:

Employer:

Work Phone:

Ext:

NCAA Academic Information

High School/Previous College:

Graduation Date: *

School Address 1:

School City:

School State:

School Zip:

Your Coach:

Coach's Name:

Guidance Counselor's Name:

E-mail:

Guidance Counselor's E-mail:

Work Phone:

Guidance Counselor's Work Phone:

Cell Phone:

Guidance Counselor's Cell Phone:

GPA: *

If Junior College player were you a qualifier?:

SAT:

NCAA Eligibility Center ID #: *

Date To Be Tested (If not already taken):

Additional Previous College :

ACT:

SSU Potential Major

College of Business Administration:

College of Education:

College of Liberal Arts and Social Sciences:

College of Sciences and Technology:

SSU Potential Minor

College of Business Administration:

College of Liberal Arts and Social Sciences:

College of Sciences and Technology:

Athletic Information

Height: *

ft.in.

Weight: *

Uniform No.:

Events:

Other Varsity Letter Earned (Sports):

Summer Coach Name:

Summer Coach Phone:

Shoe Size: *

Summer Coach E-mail:

Sweat Suit Size: *

Tee Shirt Size: *

Tights Size: *

Events Best Times/Distances

100h/110h:

::

PV:

300h:

::

Discus:

400h:

::

Shot:

100m:

::

Hammer:

200m:

::

Javelin:

400m:

::

Triple J:

800m:

::

High J:

1600m:

::

Long J:

3200m:

::

Dec.:

Cross Country Event:

Hep.:

Name of Meet:

Cross Country Event Time:

::

Place at State Meet: