PERSONAL INFORMATION
LAST NAME: ___________________________ FIRST NAME: ________________________________

SOCIAL SECURITY NUMBER: ____________________________
DATE OF BIRTH: __________________

PARENTS/SIBLINGS NAMES: _____________________________________________________________

HOME ADDRESS
STREET:  ________________________________________________ 
                  ________________________________________________

CITY:  ________________________________________________ 
STATE/ZIP: ___________________________________________

PHONE:  ________________________________________________ 
EMAIL:   ________________________________________________

HIGH SCHOOL:  ________________________________________________ 
HIGH SCHOOL CODE:   ________________________________________________
GPA: _______________
SAT: _______________
ACT: _______________

INTENDED COLLEGE MAJOR: __________________________________________

HAVE YOU SENT INTO THE NCAA CLEARING HOUSE?:  YES NO
IF YES, WHAT IS YOUR CLEARING HOUSE NUMBER: _______________________________

RUNNING INFORMATION
HOW MANY MILES DO YOU RUN?    DAILY: __________________ WEEKLY: __________________       

DISTANCES/PERSONAL BESTS:

400:_________  1 MILE: __________  5K:__________  800:_________  2 MILE: __________  10K:_________ 
Other: ______________________________________________________________________________________
______________________________________________________________________________

OTHER INTERESTS/ACTIVITIES (SPORTS, CLUBS, HOBBIES, ETC…)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
_______________________________________________________________________________