Name:  Last     First    MI
                                                                                                                                      
Graduation Year: 2005 2006 2007 2008 2009 2010         E-Mail:  

Home Address:     
City:            State:    Zip:       

Home Phone:     Social Security No.(optional):      

Name of Parents or Guardian: (Father)(Mother)
Occupation: (Father)   (Mother)

High School Name:        School Phone:
 School Address:     
City:            State:    Zip:       

High School Coach's Name:     Coach's Home Phone:

Number in Class:          Class Rank:          Grade Point Average:    
Academic majors you are interested in:
S.A.T. -  Verbal:  Math:       ACT -

Height:   Weight:                 Position:

Statistics:   Points/game -    Rebounds/game -    FG%-  FT% -

Would you be interested in visiting Lock Haven University? Yes No

Are films/tapes available of you in action?  Yes No

Please list any camps/tournaments attending this year:

LHU Men's Basketball
Head Coach John Wilson, Jr.
Assistant Coaches: Doug Wingard, Johnny Wilson
Thomas Fieldhouse
Lock Haven University
Lock Haven, PA 17745
O: (570) 893-2097
F: (570) 893-2414