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This form will be submitted directly to Head Coach of Track & Field Bob Duley

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
Height: Weight:
Name of high school track & field coach:
Event 1 (time/distance/height):
Event 2 (time/distance/height):
Event 3 (time/distance/height):
Event 4 (time/distance/height):
Event 5 (time/distance/height):
Please list any honors or statistics you earned in high school track and field: