MID MICHIGAN COLLEGE LAKERS

Prospective Athlete Form

PERSONAL INFORMATION

Full Name *

First Name Last Name

E-mail *

Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Date of Birth *

Parent Name *

First Name Last Name

Parent Phone *

- Area Code Phone Number

ACADEMIC INFORMATION

High School Name *

High School Grad Year *

High School City and State *

High School GPA *

ACT Score

SAT Score

Have you attended another college/university? *

Yes No

List all colleges/universities that you have attended.

What Academic Program / Major are you interested in at Mid? *

www.midmich.edu/pathways for more infomation

ATHLETIC INFORMATION

What sport are you interested in? *

Men's Basketball Women's Basketball Men's Bowling Women's Bowling Men's Cross Country Women's Cross Country Club Hockey (Co-Ed) Baseball Softball

What is your high game? *

What is your series average? *

What sport are you interested?

Men's Basketball Women's Basketball Men's Bowling Women's Bowling Men's Cross Country Women's Cross Country Club Hockey (Co-Ed) Baseball Softball

What is your top 5K time? *

Primary Position *

Secondary Position *

Top Fastball Velocity *

Pop Time *

Batting Average *

Position(s) Played

Height *

Weight *

Points per game *

Rebounds per game *

Assists per game *

Primary Hockey Position *

High School Coach Name *

High School Coach Contact Information (Phone or Email) *

Non-School or Travel Team

Non-School or Travel Team Coach Name

Non-School Coach Contact Information (Phone or Email)

List any honors, achievements, highlight reels or links that we should know about.

Are you interested in playing multiple sports at Mid? *

If you answered yes, please indicate what other sports you want to play. (Select all that apply) *

Men's Basketball Women's Basketball Men's Bowling Women's Bowling Men's Cross Country Women's Cross Country Club Hockey (Co-Ed) Baseball Softball