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Personal Information
Graduation Year *
First Name * Middle Name
Last Name * Preferred Name
Address * City *
State * Zip *
Social Security No
Email *
Home Phone Cell Phone *
Birth Date Clearinghouse
Facebook Username
Family Information
Father's Name Father's Occupation
Father's Employer Father's Home phone #
Father's Work phone # Father's Cell phone #
Father's Email Father's College
Mother's Name Mother's Occupation
Mother's Employer Mother's Home phone #
Mother's Work phone # Mother's Cell phone #
Mother's Email Mother's College
Marital Status  
I live with If other:
The names and ages of my siblings are:
Athletic Information
position 1 position 2
points/game assists/game
rebounds/game blocks/game
Height ft in Weight
Jersey NumberOther Sports
My online video link is:
Scholastic Information
My projected major is:
School State *
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School Type
School Name School Address
School City School ZIP
School Country
School Phone School Fax #
Counselor's First name Counselor's Last name
Coach's First Name Coach's Last Name
Coach's Work Phone Coach's Home Phone
Coach's Cell Phone Coach's Email
AAU/Club Team Information
Club Team Name
Coach First Name Coach Last Name
Coach Work Phone Coach Cell Phone
Coach Email Alma Mater
Academic Information
SAT Math SAT Verbal
SAT Combined SAT Written
General Information
Asthma *
Learning disabilities *
My top priorities in choosing a college are:
1. 2. 3.
The students and alums I know are:
My favorites hobbies are:
The person that will help me choose a college is: Cell phone:
The 5 schools I plan to visit are:
1. 2. 3. 4. 5.
Transcript Release
I authorize the release of my transcript and test scores to the United States Military Academy.
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