Personal Information

Required Fields **

Name**

Address

City

State

Zip / Postal

Country

Telephone**

Cell Phone

Email**

Date of Birth

Parents' Names

Academic Information

High School Name

College Name (if applicable)

High School Address

High School Phone

High School Graduation Date (MM-DD-YY)**

Current Grade in School**

Intended Major at Southern Illinois

High School Grade-Point Average

College Grade-Point Average (if applicable)

Class Rank (x of x)

SAT Score (verbal and math)

ACT Score

Do you plan to take either test again?

Yes
No

If yes, which one and when?

Have you ever applied to Southern Illinois?

Yes
No

Do you intend to apply for financial aid at Southern Illinois?

Yes
No

Academic Honors

Other colleges you are interested in

Are you registered with the NCAA Eligibility Center?

Yes
No

If yes, enter registration number

Athletic Information

Primary sport you are interested in

Other sports

Height

Weight

Current Team (if different from high school)

Letters Won in this sport

Coach's Name

Coach's Phone

Position/Event

Left/Right Handed

Athletic Honors (all-conference, all-state, all-area, etc.)

Team Highlights in career:

Club, AAU or other organized playing experience