GENERAL:

Name:                         Date:
Social Security No.:      Graduation Year:     Birth Date:
Street Address:     City:
State:    Zip:
Phone: E-Mail:

Parents' Names:
Occupations:

ACADEMIC:

High School:
School Address: School Phone:
G.P.A.    Class Rank of      S.A.T. Scores  V:  M:
Interest of Study at Lock Haven:

ATHLETIC:

Position:    RT/LT Handed:
Height:   Weight:    Number of years you have played:
Coaches Names:    Phone:

Camps/Clinics attended (YR, awards):

Have you ever participated in any state games?  Yes  No    When?
Other sports you participate in:

List any serious injuries you have had:

List any athletic awards you have received:

Tape of skills and/or competitions available?     Yes     No