Student Athlete Interest Form

Personal Information Entries marked with * are required fields.
email *
First Name: *
Last Name: *
Street: *
City: *
State: *
Zip: *
Phone:	( )

Academic Information
High School:
Address:
City:
State:
Zip:
Phone:	( )

Graduation Date (If still in High School):
Have you applied for admission?	Yes    No

Athletic Information
H.S. Coach's Name or Club:
Height (feet-inches):
Weight:

Sport you are interested in playing at SMCC*

Other sports played *