Personal Information
First:
Last:
Address:
City:
State: Zip:
Date of Birth: Height:
Home Phone: Weight:
Cell Phone    
email:

Family Information
Parents Names
Occupations
Colleges
E-mail Address

Athletic Information
Position:
Years of experience: Years as starter:
High School Coach: Phone:
HS Coach Mailing Address
HS Coach Email Address
Strengths Needs Improvement:
Goals FR SO JR SR
Assists FR SO JR SR
Goalies (Shutouts) FR SO JR SR
Team Record FR Team Record SO
Team Record JR Team Record SR
Athletic Honors
Other Outstanding Athletes in your school or area?
Name School:

Academic Information
High School:    
Address
Guidance Counselor
Counselor Phone/Email:
GPA Grad Yr.
Class Rank: Class Size:
PSAT Written: PSAT Verbal: PSAT Math:
SAT Written: SAT Verbal: SAT Math:
ACT English ACT Written ACT Math
ACT Science Composite ACT Score
SAT II
List Subject Names and Scores
AP Courses
Test Scores
Academic Interests
Academic Honors
Community Activities
Have you submitted an application?
Would you like to receive an application?
Are you applying early decision?
Will you be applying for financial Aid?
Have you completed your CSS/Profile?
Are you planning a campus visit? When?
List in order of preference, the Colleges you are
interested in attending (including Brandeis)
1.
2.
3.
4.