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Personal Information
First Name: *
Last Name: *
Campus Visit Interest: *
Yes
No
Have already visited
Middle Name:
Preferred Name:
Preferred Date to Meet with Staff on Campus:
Email: *
Columbia Connection?:
Address: *
City: *
State:
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Zip:
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Place of Birth:
Mobile/Alt. Phone: *
Date of Birth: *
Parent/Guardian Contact Information
First Name: *
Last Name: *
Relationship: *
Father
Mother
Alternate
Step Mother
Neighbor
Uncle
Sister
Grandfather
Guardian
Aunt
Friend
Step Father
Brother
Grandmother
Coach
Other
Spouse
Parent
Girlfriend
Boyfriend
Child
Guidance Counselor
Wife
Cousin
Husband
Club Director
Step Sister
Step Brother
Athletic Director
Phone: *
Mobile Phone:
Email:
College Name:
Occupation:
Employer:
Work Phone:
Ext:
Parent/Guardian Contact Information
First Name: *
Last Name: *
Relationship: *
Father
Mother
Alternate
Step Mother
Neighbor
Uncle
Sister
Grandfather
Guardian
Aunt
Friend
Step Father
Brother
Grandmother
Coach
Other
Spouse
Parent
Girlfriend
Boyfriend
Child
Guidance Counselor
Wife
Cousin
Husband
Club Director
Step Sister
Step Brother
Athletic Director
Phone: *
Mobile Phone:
Email:
College Name:
Occupation:
Employer:
Work Phone:
Ext:
Athletic Information
Height:
ft.
in.
Weight:
Event List:
06/23/2015 - 2015 National Futures Championships
06/29/2015 - Futures Elite Tournament
07/09/2015 - 2015 National Club Championships
07/15/2015 - Brown Bear Summer Camp
07/20/2015 - Fairfield Revolution Day Camp
08/01/2015 - 2015 Columbia CN19 Field Hockey Camp
Upcoming High School hockey schedule:
Number of Years Played:
Additional Team Responsibilities (i.e. Captain):
Athletic Honors:
Jersey Number (Home):
Jersey Number (Away):
Jersey Color (Home):
Jerser Color (Away):
Primary Position:
Secondary Position:
100 yd time:
:
:
1 mile time:
:
:
Academic Information
SAT Math:
SAT Verbal:
SAT Writing:
ACT:
Class: *
High School
2-Year College
4-Year College
Post-High School, Non-College
GPA (unweighted): *
Class Rank:
Grad Year: *
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Registered with NCAA Eligibility Center: *
Yes
No
NCAA Eligibility ID #:
Intended Major:
1st College Preference:
2nd College Preference:
3rd College Preference:
School Information
School Name: *
Clear
High School Competition Address: *
School Address 1: *
School Address 2:
School State:
AL
AK
AR
AS
AZ
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AB
AE
BC
DC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
UN
YT
PR
VI
School City: *
School Country:
School Zip:
Fax:
Phone:
Mascot:
Colors:
Website:
Guidance Counselor's First Name:
Guidance Counselor's Last Name:
Guidance Counselor's Email:
Guidance Counselor's Phone:
Guidance Counselor's Fax:
School Coach Information
Your Coach:
Select your head coach
My coach isn't in this list, I'll provide the information below
First Name: *
Last Name: *
Email:
Title:
Work Phone:
Mobile Phone:
Club Team Information
Club Team Name: *
Clear
Club jersey number: *
Upcoming Club Competition schedule:
Your Coach:
Select your head coach
My coach isn't in this list, I'll provide the information below
Club Coach First Name: *
Club Coach Last Name: *
Club Coach Email: *
Club Coach Phone: *
Website:
Team Address 1: *
Team Address 2:
Team City: *
Team State: *
AL
AK
AR
AS
AZ
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AB
AE
BC
DC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
UN
YT
PR
VI
Team Zip: *
Team Country:
Colors:
Fax:
Secondary Club Coach Information
Club Team Coach Name: *
Title:
Club Coach Email:
Club Coach Cell Phone: