General Information 

Name     Email Address

Home Address 

City     State     Zip 

Home Phone     Cell Phone  

Date of Birth     SS# 

Father's Name  Occupation  Bus. Phone 

Mother's Name  Occupation  Bus. Phone 

Academic Information

High School 

Address 

Academic Interests 

SAT Scores:  Verbal     Math    

                     Written            Date Taken

Class Rank/Total     GPA     Date of Graduation 

Athletic Information 

High School Coach     Coach's Home Phone 

Height     Position     Jersey Number 

Points Per Game     Rebounds Per Game     Assists Per Game 

Years as a Starter (including senior year)  

Awards (Captain, All-Conference, etc.) 

Friends/Relatives attending or graduates of Lycoming