Personal Information Prospect Code: First Name: * Last Name: * Middle Name: Preferred Name: Email: * Facebook Email: 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: Phone: * Mobile/Alt. Phone: Gender: M F Place of Birth: Date of Birth: * Siblings Names and Ages:   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: * Discipline: * English Western Other # Years of Riding Experience: Member of Association: USEF USAE AQHA APHA NRHA Other Farm Name: Current Trainer Name: ENGLISH Assoc competed in (i.e. AQHA, USEF): WESTERN Assoc competed in (i.e. AQHA, NRHA): Upcoming Show Schedule: List Medal Finals you've qualified or competed: Awards: Level of Competition: Events currently competing in: Member Assoc. Registration Number: Amount of prize money won: Points earned in those classes: List any injuries or surgeries: Additional Pertinent Information: Previous year Points earned per class: Have you competed in USEF Medal, Maclay, USET and/or WIHS: Youtube or Video Link: Current year Points earned:   Academic Information Class: * High School 2-Year College 4-Year College Post-High School, Non-College Grad Year: * 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Class Rank: Non Weighted GPA: * Intended Major: Other Schools of Interest: Reg. with Eligibility Center: Yes No Eligibility Center #: Did you indicate that UGA be notified of your SAT/ACT: Yes No What interests you in UGA?: List any academic honors: Other Activities: Additional Pertinent Academic Information: Visit Planned to UGA: Yes No Date of Visit: Applied to UGA: Yes No Date Applied: College Admissions Exams Taken: ACT SAT PSAT Scheduled None SAT: SAT Math: SAT Verbal: ACT: Test Taking 1: ACT SAT Scheduled Date 1: Test Taking 2: ACT SAT Scheduled Date 2:   School Information School Name: * Clear School Address 1: * School Address 2: School City: * 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 Zip: Phone: