Coffeyville Community College Track and Cross Country
Prospective Student-Athlete Information Form

 

Note: This form is not in itself an application for collegiate admission.  It merely serves to facilitate a determination of certain criteria used in the recruiting of prospective student-athletes.

Name: 

Street Address: 

City:   

State:   Zip Code: 

Country:  

Email Address:

Phone Number:  () -    Sex:

Date of Birth (MM/DD/YY):  //

Date of Graduation (MM/YY):  /

Height (ft/in):     Weight (lbs): 

Non-Athletic Activities

Student Body Officer    Editor/Writer School Publications
Class President              National Honor Society
Other
Field of Study:

Academic Information

Class Rank   out of

GPA   on a scale of 

Test Scores:

SAT: Date (MM/DD/YY) ( // ) Verbal Math

ACT: Date (MM/DD/YY) ( // ) Composite

Achievement Scores 

High School Information

High School Name Year in School
Street Address
City  
State Zip Code
Phone Number ()
Counselor Name

Athletic Background

Tip:  Text boxes below will scroll to the right as you type the requested information.  You should have plenty of space to list the information; however, you certainly want to avoid writing a novel.

Events Time/Distance Date/Place Coach Name/Phone#

 

Other Sport Position Varsity Letter? Honors

 

Interest Level

Please indicate the level of interest you currently have in attending CCC.
(Scale from 1 to 5, with 1 = slightly interested, 5 = will be attending)

Interest Level
Other Colleges I'm currently looking at

Do you intend to apply for financial aid while attending college?  Yes No  (Answer Required)

Thanks for taking the time to fill out this questionnaire.  To submit this form to the CCC Track Coaches, press the submit button below.