Have you completed your sophomore year of high school?    Yes No

PERSONAL INFORMATION

Today’s Date
First Name
Last Name
Address 1
Address 2
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Europe Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  Zip
E-Mail
Home Phone
Date of Birth

Are you registered with the NCAA Clearinghouse?

Yes No

FAMILY INFORMATION

Father
First Name
Last Name
Occupation
Work Phone
Home Phone
E-Mail

Mother
First Name
Last Name
Occupation
Work Phone
Home Phone
E-Mail
Number of Siblings

HIGH SCHOOL AND ACADEMIC INFORMATION

Graduation Date
High School Attended
H.S. Address 1
H.S. Address 2
H.S. City
H.S. State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Europe Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  Zip
H.S. Phone
Academic Counselor
Counselor Phone
Anticipated Area(s) of Study

TEST SCORES

G.P.A.		PSAT
SAT		ACT

COMMUNITY COLLEGE/FOUR-YEAR COLLEGE BACKGROUND

Number of full time quarters/semesters attended
Total number of transferable units passed (if known)
GPA
Will you receive your A.A. degree?	Yes No
If yes, which term/year

FOOTBALL INFORMATION

Position(s) Played
Height	5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0"
Weight	120-130 lbs. 131-140 lbs. 141-150 lbs. 151-160 lbs. 161-170 lbs. 171-180 lbs. 181-190 lbs. 191-200 lbs. 201-210 lbs. 211-220 lbs. 221-230 lbs. 231-240 lbs. 241-250 lbs. 251-260 lbs. 261-270 lbs. 271-280 lbs. 281-290 lbs. 291-300 lbs. 301-310 lbs. 311-320 lbs. 321-330 lbs. 331-340 lbs. Above_341 lbs.
Strength	Max
Flat Bench Press
Parallel Squat
Dead Lift
Speed	Top Time
40 Time
100 Time
Please List Athletic Achievements

HIGH SCHOOL COACH

First Name
Last Name
Phone
E-Mail

Please List Other Schools You Are Interested In
Why Are You Interested in Sacramento State?