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Personal Information (Highlighted Fields Are Required. Input "N/A" or "0" for Not Applicable)
Prospect Code:
First Name: *
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Last Name: *
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Middle Name:
Preferred Name:
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Address: *
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City: *
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State:
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Date of Birth: *
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Parent/Guardian Contact Information
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Last Name: *
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Relationship: *
Father
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Step Mother
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Phone: *
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Mobile Phone:
Email:
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College Name:
Occupation:
Employer:
Work Phone:
Ext:
Athletic Information
Coach's Name: *
*Required
Coach's Phone Number: *
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Primary Sport : *
Track and Field
Cross Country
*Required
Height: *
ft.
in.
*Required
Event 1: *
*Required
Event 1 Time/Distance: *
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Event 2:
Event 2 Time/Distance:
Event 3:
Event 3 Time/Distance:
Academic Information
ACT: *
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SAT:
Do you plan to take either test again: *
Yes
No
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High School GPA: *
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Class Rank: *
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High School Graduation Year: *
2020
2021
2022
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2025
2026
2027
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Have you applied to CSC:
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No
Registered with Clearinghouse: *
Yes
No
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Intended Major: *
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1st College Preference: *
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2nd College Preference: *
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3rd College Preference:
School Information
High School Name: *
Clear
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Phone:
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School Address 2:
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School Zip:
School State: *
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AR
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AZ
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DE
FL
GA
HI
ID
IL
IN
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KS
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ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
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NY
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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
*Required
School Country:
Name of previous College Attended: *
*Required
Graduation Year: *
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