Prospective Student-Athlete Form

Student's First Name:
Student's Last Name:
Parent's/Guardian's Name:
Address 1:
Address 2:
City, State, Zip:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Country:
Male / Female:	Male Female
Date of Birth	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
E-mail:
Telephone:
Current School:
Type of School	Public Private Parochial
Applying for Grade:	9th 10th 11th 12th PG
Applying for Academic Year of:	Jan 2007 Fall 2007 Fall 2008
Athletics Information
What sports do you play?
Fall:
Winter:
Spring:
Summer:
Height: (optional)
Weight: (optional)
Sport 1
Favorite Sport:
Position(s):
Team name(s):
Coach name(s):
Coach e-mail(s):
Coach phone(s):
Please comment on achievements or statistics:
Sport 2
Other Sport:
Position(s):
Team name(s):
Coach name(s):
Coach e-mail(s):
Coach phone(s):
Please comment on achievements or statistics:
Sport 3
Other Sport:
Position(s):
Team name(s):
Coach name(s):
Coach e-mail(s):
Coach phone(s):
Please comment on achievements or statistics:
What other schools are you considering?
Have you scheduled a campus visit at Cushing?	Yes No
If yes, what day?	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Have you received admission materials from Cushing?	Yes No