This page requires JavaScript to be enabled on your browser.
Please enable JavaScript and then reload this page.
Personal Information
Prospect Code:
First Name: *
Preferred Name:
Middle Name:
Last Name: *
Address: *
City: *
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
Zip: *
Country:
Mobile/Alt. Phone:
Email:
Phone:
Date of Birth:
Place of Birth:
Gender:
M
F
Additional Personal Information
Siblings:
Interest Level in Attending UCLA:
High
Medium
Low
Not Interested
Family/Friends Who Have Attended UCLA:
1st College Preference:
Family/Friends Who Live Near UCLA:
2nd College Preference:
Reason 1 for choosing college:
3rd College Preference:
Reason 3 for choosing college:
4th College Preference:
Reason 2 for choosing college:
Hobbies:
Father Contact Information
First Name: *
Last Name: *
Phone:
Mobile Phone:
Work Phone:
Email:
Employer:
Occupation:
College Name:
Mother Contact Information
First Name: *
Last Name: *
Phone:
Mobile Phone:
Work Phone:
Email:
Employer:
Occupation:
College Name:
Additional Personal Contacts
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:
Work Phone:
Email:
Employer:
Occupation:
College Name:
Athletic Information
Height: *
ft.
in.
Weight: *
L or R Handed/Footed:
List Injuries:
Event 1:
Event 1 Time:
Event 2:
Event 2 Time:
Event 3:
Event 3 Time:
Event 4:
Event 4 Time:
Academic Information
Grad Year: *
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
SAT:
Class: *
High School
2-Year College
4-Year College
Post-High School, Non-College
SAT Math:
Registered with Clearinghouse: *
Yes
No
SAT Verbal:
Eligibility Center ID:
SAT Writing:
Intended Major:
ACT:
GPA:
School Information
School Name: *
Clear
School Address 1:
Phone:
School City:
Fax:
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
Website:
School Zip:
Colors:
School Country:
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:
Title:
Email:
Mobile Phone:
Work Phone:
Team Information
Team Name:
Clear
Team Address 1:
Phone:
Team City:
Fax:
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
Website:
Team Zip:
Colors:
Team Country:
Team 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:
Title:
Email:
Mobile Phone:
Work Phone:
Club Coach: College Attended: