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PERSONAL/FAMILY INFO
First 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: *
Home Phone: *
DOB: *
Cell: *
Facebook: *
Twitter: *
Instagram: *
Snapchat: *
Skype: *
Email: *
Brothers and Sisters: *
Who do You Live With: *
Both
Father
Mother
Other
Family/Friends Who Have Attended Georgia Tech: *
Family/Friends Who Live in Atlanta: *
ACADEMIC INFO
Graduation Year: *
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
School: *
Clear
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: *
Phone: *
Fax Number: *
Guidance Counselor's First Name: *
Guidance Counselor's Last Name: *
Phone: *
GPA: *
ACT: *
SAT: *
Reading: *
Math: *
Writing: *
Academic Interest (Major): *
Parent/Guardian Contact Information
Father's First Name: *
Father's 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:
Father's Email:
Alma Mater:
Occupation:
Employer:
Work Phone:
Ext:
Parent/Guardian Contact Information
Mother's First Name: *
Mother's Last Name: *
Relationship (Select Mother): *
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:
Mother's Email:
Alma Mater:
Occupation:
Employer:
Work Phone:
Ext:
Schools You Are Interested in (Rank in Order of Interest):
1: *
2: *
3: *
4: *
5: *
Any Previous Injuries: *
Two Most Influential Living Persons in Your Life:
1: *
Phone: *
Email: *
2: *
Phone: *
Email: *
List Camps Attended Last Year: *
BASKETBALL INFO
Height: *
ft.
in.
Position: *
Scoring Average/PPG: *
Rebounding Average/RPG: *
Assist Average/APG: *
HS #: *
AAU #: *
Other Sports: *
Athletic Honors: *
Your Coach:
Select your head coach
My coach isn't in this list, I'll provide the information below
H.S. Coach First Name: *
H.S. Coach Last Name: *
H.S. Coach Cell: *
H.S. Coach Email: *
AAU Team Name: *
Clear
Your Coach:
Select your head coach
My coach isn't in this list, I'll provide the information below
AAU Team Coach First Name: *
AAU Team Coach Last Name: *
AAU Coach Cell: *
AAU Coach Email: *
The completion of this form does not commit you or Georgia Tech.
I hereby authorize the release of my transcript to a Georgia Tech representative.
Signature (Typed Name):: *
Date: *