Cross Country/Track and Field Prospective Athlete

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ZIP Code *

Email address *

Cell Phone Number *

Address 2

City *

Address 1 *

Last name *

State *

First name *

Year of Graduation

Date of Birth

High School

Coach

Coach's Home Phone

Rank in Class

PSAT Score

SAT(M)

SAT(V)

High School GPA

Desired College Major

Personal Bests: (indicate your best performances in any of these events)

100

200

400

800

1600/Mile

3200/Two Mile

5000 (track)

5000 (xc)

Javelin

Shot Put

Discus

100/110 Hurdles

Low/Intermediate Hurdles

High Jump

Pole Vault

Triple Jump

Long Jump

Others

Years of Participation in Track/Cross Country

Athletics Awards/Honors

How would you rate your interest in Behrend?

Top Choice Top 2-3-4 Possibly

Have you applied to Behrend?

Yes No

Do you plan to apply?

Yes No

Additional Information

* required field