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

Person Bests: (Indicate your best performance in any of these events)

100:

200:

400:

800:

1600/mile:

3200/2 mile:

5000(track):

5000(xc):

Javelin:

Shotput:

Discus:

100/110 Hurdles:

Low/Intermediate Hurdles:

High Jump:

Pole Vault:

Triple Jump:

Long Jump:

Others:

Years of Participation in Track/Cross Country

Athletic Awards and 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