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Ripon College

Prospect Questionnaire

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This form will be submitted directly to Head Coach of Cycling Ric Damm
PERSONAL INFORMATION
First name:		Last name:
Address:
City:		State:
Country:		Zip:
Phone:	( ) -	E-mail:
Mother's Name:		Her Occupation:
Father's Name:		His Occupation:
		Living With:

ACADEMIC INFORMATION
High school:		Grad year:
ACT score:		Class rank:
SAT verbal:		Class size:
SAT math:		GPA:
Possible academic major:	Check to indicate undecided at this time.

ATHLETIC INFORMATION
Are you currently a member of or have you participated on a high school cycling team?
If yes, name of high school coach:
Are you currently a member of or have you participated on a shop or other sponsored team?
If yes, name of shop or team:
Do you currently or have you held a USA Cycling license?		If yes, select type(s) below.

Please list your top five results in the fields below. Or email your race resume to dammr@ripon.edu. Please include event name, date, location, category, distance, field size and any other information you feel pertinent:
1.
2.
3.
4.
5.
Please list any honors or recognition you've earned as a cyclist: