PERSONAL:

Name: (Last)  
(First) , (MI)

Phone: E-Mail:

 Street Address:     
City:
State:    Zip:       

Social Security No.(optional):                          
Birth Date:

Father's Name:                  
College Attended:
Father's Occupation:          
Company Name:

Mother's Name:                
College Attended:
Mother's Occupation:       
Company Name:

Brother(s)/Sister(s):

Parents are (check applicable): 
Married  Separated Divorced, live with Father  Divorced, live with Mother  
Live with Grandparents  Live with Relatives  Other - explain

ACADEMIC:

School Name:        
Head Coach's Name:
Guidance Counselor's Name:   

Date of Graduation: January February March April May June July August September October November December 2007 2008 2009 2010 2011 2012 2013 2014     
Test Scores:  S.A.T. -  Verbal:  Math:                    ACT -

Academic major you are interested in:

ATHLETIC:

Height:   Weight:                 Speed: (40 time)           Jersey Number:

Positions:   Offense:                    
Defense:   
  Punter  Kicker  Long Snapper  Holder - PAT/FG  Punt/Kick-off Returner

Serious Injuries?   Yes No
     If yes, explain:

Other Sports Participated In: Basketball  Wrestling  Baseball  Track & Field
   Other - explain:

MISCELLANEOUS:

LHU Alumni/Students you know:

LHU Football
Head Coach: John Klacik
Thomas Fieldhouse
Lock Haven University
Lock Haven, PA 17745
O: (570) 484-2250
F: (570) 484-2414