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    ACT comp:

Class Rank/Total     GPA     Date of Graduation 

Athletic Information 

Height     Weight  Soccer Position   Years Varsity

High School Coach     

Coach's Home Phone    Coach's Office Phone    

Club Team 

Club Team Coach    Club Coach Phone 

Awards (Captain, All-Conference, etc.) 

Other sports you want to play in college

Friends/Relatives attending or graduates of Lycoming