Personal Information

Full Name     

Street Address

City    State   Zip

Home Phone     Cell Phone     E-Mail Address

Age  Date of Birth Height Weight

Father's Name     Father's Occupation

Mother's Name     Mother's Occupation

Academic Information

School Name

School Phone Number

School Address

City    State   Zip

Graduation Date   Class Rank

GPA   ACT   SAT   FASA

Intended College Major  

Athletic Information

Position(s) Played

High School Coach  

Coach's Office Number Coach's Home Number

PPG     RPG     FG%     3 Pt. FG%     FT%

Team Record

Honors

Submit to:           Coach Kelly Britsky

                                    800 Georgia Southwestern State University Drive

                                    Americus, GA 31709

                                    fax:  (229) 931-2143