Name: (first) (last) (middle in.) Street Address: City: State: Zip Code: Home Phone: Cell Phone: Email Address: Date of Birth: Father's Name: Occupation: Work Phone: Mother's Name: Occupation: Work Phone:
School Name: School Address: City: State: Zip Code: Date of Graduation: Guidance Counselor: Phone: Coach: Phone: Class Rank: Grade Point Average: S.A.T. - Verbal Math: Academic Honors: Academic Majors You Are Interested in: Do you have an application to Shippensburg University? Yes No Have you applied to Shippensburg University? Yes No Have you been accepted to Shippensburg? Yes No Have you completed and mailed the NCAA Clearinghouse information? Yes No If Yes, what date did you submit your information to the NCAA?
Interested in Lacrosse Field Hockey Both
Height: Weight: Position: Uniform Number: Years Played: Years Played Varsity League/Conference: Do you have a video available? Y N Have you played at the National Hockey Fest? Y N Other Sports Played Awards/Recognitions: Indoor or Tournament Experience: Any Additional Information:
