Personal Information

Full Name   Preferred Name

Street Address

City    State   Zip E-Mail Address

Age  Date of Birth Height Weight

Parent's Name (s)

Parent's Street Address

City    State   Zip Phone Number

When is the best time to call? 

Parent's Occupation(s) 

Academic Information

School Name

School Phone Number

Graduation Date   Class Rank

GPA   ACT   SAT:  Verbal   Math

Intended College Major   Counselor's Name

Athletic Information

Current Soccer Club Team

Club Coach   Coach's Phone Number

Position(s) Played Position(s) Desired

Stats/Info

High School Coach   Coach's Phone Number

Upcoming Tournament you will be participating in

How important will soccer be in your decision about college? 

Other Information

Have your parents filed a Free Application for Federal Student Aid (FAFSA)?  Yes  No

List any friends or members of your family who attend or have attended Georgia Southwestern and their relationship to you.   

                        Name                                                        Relationship

How did you hear about GSW? 

Submit to:           Coach Barry Kaplan

                                    800 Wheatley Street

                                    Americus, GA 31709

                                    fax:  (229) 931-2143