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 2005 2006 2007 2008 2009 2010    

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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: