Personal Information - Cross Country
First:
Last:
Address:
City:
State: Zip:
Citizenship
(if not US):
Date of Birth: Height:
Home Phone: Weight:
Cell Phone When is a good time to call?
email:

Family Information
Parents Names
Occupations
Colleges
E-mail Address

Athletic Information
High School Coach: Phone:
E-mail Address
Years of experience: Years varsity:
Strengths Needs Improvement:
Results

1. Event: Best: Date:

2. Event: Best: Date:

3. Event: Best: Date:

4. Event: Best: Date:

5. Event: Best: Date:

6. Event: Best: Date:

Athletic Honors
Team Record FR Team Record SO
Team Record JR Team Record SR
Other Outstanding Athletes in your school or area?
Name School:

Academic Information
High School:    
Address
Guidance Counselor
Counselor Phone/Email:
GPA (Weighted)
Grad Yr.
GPA (Unweighted)
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.