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Personal Information

Prospect Code:

First Name: *

Last Name: *

Middle Name:

Preferred Name: *

Gender: *

Address:

City:

State:

Zip:

Country:

Phone:

Mobile/Alt. Phone:

Email: *

Twitter:

Instagram:

Snapchat:

Date of Birth: *

Brothers/Sisters (include names and ages):

Parent/Guardian Contact Information

Father's Name: *

Father's Last Name: *

Relationship: *

Phone: *

Father's Cell Phone:

Father's Email:

Father's Alma Mater:

Father's Occupation:

Employer:

Work Phone:

Ext:

Academic Information

Have you registered with the NCAA Clearinghouse?: *

Eligibility Center ID:

High School/Junior College Name:

Clear

School Phone:

Grad Year: *

Guidance Counselor's Name:

Guidance Counselor's Phone:

College Name (if applicable):

College GPA (if applicable):

Academic Honors:

Intended Major:

SAT Written:

SAT Verbal:

SAT Math:

Core GPA:

ACT:

TOEFL Score:

Did you request that your test scores be sent to UT Austin?:

Athletic Information

Height:

ft.in.

Weight:

Your Coach:

Coach's Name:

Coach's Email:

Coach's Phone:

Club Team:

Club Coach's Name:

Club Coach's Phone:

Club Coach's Email:

Please select your Event Discipline:

Event 1:

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Event 1 Personal Best: SO:

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Event 1 Personal Best: SR:

Event 2:

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Event 3:

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Event 4:

Event 4 Personal Best: FR:

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Other Sports:

Parent/Guardian Contact Information

Mother's Name: *

Mother's Last Name: *

Relationship: *

Phone: *

Mother's Cell Phone:

Mother's Email:

Mother's Alma Mater:

Mother's Occupation:

Employer:

Work Phone:

Ext: