Name: Last First MI Social Security No.(optional): E-Mail:
Street Address: City: State: Zip:
Home Phone: Age: Birth Date: Height: Weight: Church Affiliation (optional):
Father's Name: Father's Occupation: Mother's Name: Mother's Occupation:
Number of Brothers: Number of Sisters:
High School/Junior College: Date of Graduation: January February March April May June July August September October November December 2007 2008 2009 2010 2011 2012 2013 2014
Scholastic Average (GPA): College Curriculum Preferred:
American College Testing Composite Score (ACT): S.A.T. - Verbal: Math:
Rank in Class: Number in Class:
List Additional Athletics Participated in During High School:
Academic Honors, Athletic Honors, Club Offices, etc.:
Do you have an application for admission to Lock Haven University? Yes No
Have you applied to Lock Haven University? Yes No Have you been accepted to LHU? Yes No
I have completed and mailed the NCAA Clearinghouse information to the NCAA. Yes No
Cross Country
Distance: Best Time/Date: Average
Track
Event: Track & Field events 55/60 Meters 100 Meters 200 Meters 400 Meters 500 Meters 800 Meters 1000 Meters 1500 Meters Mile/1600 Meters 3000 Meters 3200 Meters 5000 Meters 10000 Meters 55/60 Hurdles 110/100 Hurdles 300/400 Hurdles Shot Put Discus Throw Javelin Pole Vault Long Jump High Jump Triple Jump Best/Date: Average:
Additional Comments:
LHU Men's & Women's Cross Country Co-Head Coaches Aaron Russell & Heather Leverington Assistant Coach Chad Warren Thomas Fieldhouse Lock Haven University Lock Haven, PA 17745 O: (570) 484-2261 F: (570) 484-2414
LHU Men's & Women's Track and Field Co-Head Coaches Aaron Russell & Heather Leverington Assistant Coach Chad Warren Thomas Fieldhouse Lock Haven University Lock Haven, PA 17745 O: (570) 484-2635 F: (570) 484-2414