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Prospective Student Athlete Form


< Athletics Home < Prospective Student/Athlete Form
 
Track and Field Prospective Student Athlete
Personal Information
Today’s Date
First Name
Last Name
Parent's / Guardian's Name
Street Address
Street Address 2
City
State
Zip Code
Country
Home Phone Number
Your Cell Phone Number
Social Security Number
Birth Date
E-Mail Address

High School Students:
High School
Graduation Year
High School 
High School GPA

Transfer Students:
Are you a College Transfer Student?
If so, from what school? 
How many hours completed last semester?
Last Semester GPA

Track and Field Information

Height

High School Coach's Name:

Events and best times/distances:

Other Comments:

 

 


ICC

Pirate Athletics

1057 W. College Avenue

Independence, KS 67301

 


Main Office 620-331-4100 
FAX 620-331-0153
Athletic Office 620-332-5481
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