If you are interested in competing in cross country at Indiana State University, please complete the following
form and submit it to a member of the ISU coaching staff. This form will be used by the coaching staff to help
determine prospective student athletes. NCAA rules prohibit coaches from contacting freshman and sophomores
in high school. This form is NOT an official university application.
TODAY'S DATE: 
NCAA CLEARINGHOUSE CODE: 

PERSONAL INFORMATION

FIRST NAME: 
NAME YOU WISH TO USE: 
MIDDLE NAME: 
LAST NAME: 
SOCIAL SECURITY NUMBER/CODE: 
HOME MAILING ADDRESS: 
CITY: 
STATE: 
ZIP: 
HOME PHONE NUMBER:
BIRTHDATE:
AGE:
E-MAIL ADDRESS:
PARENT'S NAMES (OR LEGAL GUARDIAN):

HIGH SCHOOL INFORMATION

HIGH SCHOOL ATTENDED (NAME, TOWN, STATE): 
YEAR OF GRADUATION: 
HIGH SCHOOL HEAD COACH: 
HIGH SCHOOL LETTERS EARNED: 
ALL-STAR HONORS (all-state, all-region. Be sure to list sport): 
OTHER HONORS: 
PERSONAL BESTS:

COLLEGE INFORMATION

INTENDED MAJOR: 
PLANS AFTER GRADUATION: 
HOBBIES: 



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