PERSONAL INFORMATION

Today’s Date
Name
Address 1
Address 2
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Europe Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  Zip
E-Mail
Home Phone
Social Security Number
Date of Birth

Are you registered with the NCAA Clearinghouse?

Yes No

FAMILY INFORMATION

Father
First Name
Last Name
Occupation
Work Phone
Home Phone
E-Mail
Alma Mater
Mother
First Name
Last Name
Occupation
Work Phone
Home Phone
E-Mail
Alma Mater
Number of Siblings
Have any members of your family attended USD?
	Yes No
If so, who and when?
Do you know anyone (classmate, neighbor, family, friend) who has attended USD?
	Yes No
If so, who and when?

Please List Other Schools You Are Interested In

HIGH SCHOOL AND ACADEMIC INFORMATION

Graduation Date
High School Attended
H.S. Address 1
H.S. Address 2
H.S. City
H.S. State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Europe Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  Zip
H.S. Phone
Academic Counselor
Counselor Phone
Anticipated Area(s) of Study

TEST SCORES

G.P.A.		PSAT
SAT		ACT

COMMUNITY COLLEGE/FOUR-YEAR COLLEGE BACKGROUND

Number of full time quarters/semesters attended
Total number of transferable units passed (if known)
GPA
Will you receive your A.A. degree?	Yes No
If yes, which term/year

FOOTBALL INFORMATION

Position(s) Offense/Defense
Height
Weight
Strength	Max
Flat Bench Press
Parallel Squat
Dead Lift
Speed	Top Time
40 Time
100 Time
Jersey #/Color
Please List Football Honors
Video Available?	Yes No
Other High School Sports Played:

Honors In Those Sports

HIGH SCHOOL COACH

First Name
Last Name
Phone
E-Mail

COLLEGE/JC COACH

Are You a Transfer Student?

Yes   If yes, what school?   No

Coach at your previous college/JC:
Coach's Phone:
How interested are you in USD?:
Very   Moderately   Not Interested   Need More Info
Why Are You Interested in University of South Dakota?