Last Name:

Junior College currently attending:

Junior College address:

City:

State:

Zip:

Junior College Coach's Name:

Coach's Phone Number:
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Please list any other colleges you have attended

Previous High School:

High School address:

City:

State:

Zip:

What year are you in college?
Freshman
Sophomore

How many transferable (C- or better) credits do you currently have?

Which one of the following best describes your eligibility status after High School:
Full Quailfier (At least 700 SAT and 2.0 GPA in core courses)
Partial Qualifier (Either 700 SAT or 2.0 GPA in core courses, but not both)
Non-Qualifier (Neither 700 SAT nor 2.0 GPA)

SAT Score:

Did you register with the NCAA Clearinghouse while in High School?
Yes
No

What is your e-mail address?