First Name

Middle Name

Last Name

Nickname

Home Address
City	State	Zip

Home Telephone Number

Cell Phone Number

Best Time to Call

E-mail Address

Date of Birth

Family Information:

Mother's Name

Mother's College Attended

Mother's Occupation

Mother's Work Telephone

Father's Name

Father's College Attended

Father's Occupation

Father's Work Telephone

Brothers and Sisters

Name of Students, Friends, Relatives Who Are Associated with Clemson

Most Influential Person in Your Life

High School or Prep School Information:

High School or Prep School Name

School Address
City	State	Zip

Telephone

Academic Interest in College

High School Graduation Date

GPA

on a scale of

Class Rank

out of

SAT

ACT

Principal

Principal's Telephone

Guidance Counselor

Guidance Counselor's Telephone

Athletic Director

Athletic Information:

Height

Weight

Shoe Size

Dexterity
Right Left

Best Performances in Track & Field and/or Cross Country

Have you ever suffered any serious injuries?
Yes No

If so, please explain.

High School Coach Information:

Name

Office Phone

Home Phone

Cell Phone

E-mail

Club Coach Information:

Name

Office Phone

Home Phone

Cell Phone

E-mail

Additional Information:

Hobbies

Other Colleges You Are Interested In (list in order of preference)

Have you applied for admission to Clemson University?
Yes No

Have you registered in the NCAA Initial Eligibility Clearinghouse?
Yes No

Other Outstanding Track & Field/Cross Country Athletes in Your Area

Other Sport Participation

List Significant Accomplishments in Sport

List any additional information that may be helpful in evaluating your athletic ability