Earlham College
Athletics Questionnaire

Personal Information

Name:

Street Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 Code:

Phone: Date of Birth (month/day/year):

Cell Phone:

Email:

Country:
(if outside of United States)

Father/Guardian:

Occupation:

Mother:

Occupation:

Academic Information

High School:

Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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:

Date of Graduation (month/year):

Grade Point Average: ACT Score:

SAT Composite Score: Verbal: Math:

Class Rank: out of:

Your interest in Earlham College:
Tops (#1-3) Strong (#4-6) Informational
 
Top 3 College Choices:
#1
#2
#3

Athletic Information

Indicate what sport you are interested in:

High School Head Coach:

Coach's Phone:

Playing Position(s):

Club/AAU/Legion Team :

Academic Interests/Potential Major:

Athletic Accomplishments/Statistics/Awards:

Additional Information: