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:   

Academic Information:

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?  

Athletic Information:

Height:         Weight:        

Desired College Weight:   

Wrestling Accomplishments: