Mount Ida College Athletic Communications Student-Athlete Questionnaire

Email Secondary Email

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Email address *

You are a candidate for what sport? *

Position: *

First Name: *

Middle Name:

Last Name: *

Class (Select One): Freshman, Sophomore, Junior, Senior, Graduate Student: *

Major: *

Second Major/Minor: *

Height: *

Weight: *

Date of Birth: *

Place of Birth:

Permanent Address: *

City: *

State: *

Zip Code: *

Cell Phone: *

Home Phone: *

Campus E-Mail Address: *

Other E-Mail Address: *

Father's Name: *

Mother's Name: *

Brothers & Sisters (List Names & Ages): *

Name of Daily Newspaper:

Name of Weekly Newspaper:

High School Attended: *

High School Graduation Date: *

Prep School Attended (If Applicable): *

Are you a transfer student? (Yes or No) *

If yes, what school did you transfer from? *

If yes, list dates that you attended previous school to transfer: *

HIGH SCHOOL HONORS: Please list all varsity sports, letters won, all-star team, statistics, awards, etc. PLEASE PROVIDE AS MUCH DETAIL AS POSSIBLE.

Freshman/9th Grade: *

Sophomore/10th Grade: *

Junior/11th Grade: *

Senior/12th Grade: *

Prep School/Other: *

First & Last Name of your High School/Prep School Coach: *

High School/Prep School Academic Honors & Awards: *

Community Service Activities: *

Hobbies: *

Why did you choose to attend Mount Ida? *

PLEASE READ BEFORE SUBMITTING: Under the guidelines set forth by the Buckley Amendment, I understand that completion and signing of this questionnaire constitutes my permission to use any and all of this information for Mount Ida College Athletic Communications publicity purposes. I also understand that other information, both academic and athletic, will also be used for Mount Ida College Athletic Communications publicity purposes during my tenure as a student-athlete at the College.

Name (Electronic) *

Date of Submission *

* required field