Online Recruiting Form
Men's & Women's Track & Field/Cross Country

PERSONAL INFORMATION

Name - Last* First* Middle Initial*

Date of Birth (MM/DD/YYYY)*

Male Female

Home Address
            Street*    
            City*   State*   Zip*

Father - Name Occupation

Mother - Name Occupation

Home Phone Number*

Cell Phone Number

Email Address

ACADEMIC INFORMATION

High School*

Date of Graduation (MM/YYYY)*

Class Rank/Number in Class (#/#)

SAT - Date Taken (MM/YYYY) Total Score Verbal Math

Have you applied to the NCAA Clearinghouse?  Yes  No
   (What is the NCAA Clearinghouse?)

Have you applied to Kutztown University? Yes  No
   (Click here for an online university application)

Academic Program Desired at Kutztown University

ATHLETIC INFORMATION

High School Coach*

Coach's Phone Number

Height    Weight

(List your top four events, performances and the date and locations where top performance took place)
Event   Performance    Date    Meet Location
Event   Performance    Date    Meet Location
Event   Performance    Date    Meet Location
Event   Performance    Date    Meet Location

Other Varsity Sports Played

OTHER INFORMATION

Please type, in the box below, any other information you would like to submit to the coaching staff

Click this button to submit your information.  If your information is entered correctly, you will be directed to a confirmation page.

Click this button only to reset all the above fields