First/Middle/Last Name:
        

Email:
        

SSN:

Birthdate:    

Permanent Address:

Home Phone:  

Parents/Guardians/Spouse:

Height:              Weight:

Email:  

High School/Junior College:

Division/Class (A, 2A, 1, etc.):         Year Grad.:

Cross Country Coach (if applicable):

Track & Field Coach (if applicable):    

ACT/SAT Score:         Date Taken:

GPA:         Class Rank/Total Students:  

A friend who may be interested in our track program:

Year Grad:         Their school:        

Their events:
               Event #1      Best Mark:
               Event #2      Best Mark:
               Event #3      Best Mark;
               Event #4      Best Mark:

Honors (Athletic, Academic, Civic):

Please list Wayne State College and other schools
you are considering in order of preference:
                            1)
                            2)
                            3)

Academic Interests:
                           1)
                           2)