First Name: Last Name:

Preferred Name: High School Grad Year:

Birthday: (yyyy-mm-dd)

Address:

City: State: Zip:

Country:

Primary Phone:

Secondary Phone:

Best Day To Call: Choose Day No Preferred Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Best Time To Call: Choose Time No Preferred Time 7:00 a.m. - Noon 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 6:00 p.m. 7:00 p.m. 8:00 p.m. 9:00 p.m. 10:00 p.m. 11:00 p.m. 12:00 p.m.

Email Address:

School Name:

Coach Name: Coach Phone:

Coach E-Mail:

Class Rank: / GPA: ACT:

SAT Math: SAT Verbal: SAT Total:

SAT 2: SAT Subject:

Primary Academic Interest: Accounting African-American Studies American Studies Art Asian Studies Athletic Training Biochemistry Business Administration Chemistry Criminal Justice Classical Studies Communications Computer Science Economics English Enviromental Science French French Studies Gender Studies General Science Germain Studies German History Interdisciplinary Journalism Literature Mathematics Medical Technology Molecular Biology Music Philosophy Physical Education Physical Therapy Physics Political Science Pre-Architecture Pre-Engineering Pre-Law Pre-Medicine Psychology Public Relations Religion Sociology Spanish Spanish Studies Speech Teacher Education Theatre Arts Undecided Writing 4-Year Nursing

Secondary Academic Interest: Accounting African-American Studies American Studies Art Asian Studies Athletic Training Biochemistry Business Administration Chemistry Criminal Justice Classical Studies Communications Computer Science Economics English Enviromental Science French French Studies Gender Studies General Science Germain Studies German History Interdisciplinary Journalism Literature Mathematics Medical Technology Molecular Biology Music Philosophy Physical Education Physical Therapy Physics Political Science Pre-Architecture Pre-Engineering Pre-Law Pre-Medicine Psychology Public Relations Religion Sociology Spanish Spanish Studies Speech Teacher Education Theatre Arts Undecided Writing 4-Year Nursing

First Parent or Guardian:

Relationship:

Occupation:

Alma Mater:

Lives in the home? Yes     No

Second Parent or Guardian:

Relationship:

Occupation:

Alma Mater:

Lives in the home? Yes     No

Live With: Both Parents Mother Father Grandparent(s) Other

Siblings:

Height: -5'0 5'0 5'1 5'2 5'3 5'4 5'5 5'6 5'7 5'8 5'9 5'10 5'11 6'0 6'1 6'2 6'3 6'4 6'5 6'6 6'7 6'8 6'9 6'10 6'11 7'0 7'1 7'2 7'3 7'4 7'5 7'5+ Weight:

40 Yard Dash: Jersey Number: Bench Press: Squat:

Off. Position:

Def. Position:

Preferred Side: Offense Defense No Pref

Team Record: Honors:

Other Sports/Activities you participate in:

Other Sports In College?:

Current/Former Students At Yuba College You Know: