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 

Brothers Sisters

Academic Information

High School 

Guidance Counselor 

Academic Interests 

SAT Scores:  Verbal     Math    

                    Written     Date Taken

Class Rank/Total     GPA     Date of Graduation 

Athletic Information 

Height     Weight  Years on Varsity     Record 

High School Coach     

Coach's Home Phone    Coach's Office Phone    

Awards (Captain, All-Conference, etc.) 

Other sports you want to play in college

Friends/Relatives attending or graduates of Lycoming