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Personal Information
Graduation Year *
First Name * Middle Name
Last Name * Preferred Name
Address * City *
State * Zip *
Email *
Home Phone * Cell Phone
Birth Date * Registered with Clearinghouse *
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Family Information
Father's Name Father's Occupation
Father's Employer Father's Home phone #
Father's Work phone # Father's Cell phone #
Father's Email Father's College
Mother's Name Mother's Occupation
Mother's Employer Mother's Home phone #
Mother's Work phone # Mother's Cell phone #
Mother's Email Mother's College
I live with
The names and ages of my siblings are:
The best way to reach me is (choose one)
Athletic Information
off pos1 off pos2
def pos1 spec pos
squat 40 yd
bench shuttle
vertical 100 meter
power ball sparq
Height ft in Weight
Jersey Number Other Sports
My academic interests are:
My online video link is:
Scholastic Information
School State *
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School Type
School Name School Address
School City School ZIP
School Phone School Fax #
Counselor's First name Counselor's Last name
Coach's First Name Coach's Last Name
Coach's Work Phone Coach's Home Phone
Coach's Cell Phone
SAT Math SAT Written
SAT Verbal
SAT II subject SAT II score
SAT II subject SAT II score
General Information
The person that will help me choose a college is: Cell phone:
Transcript Release
I authorize the release of my transcript and test scores to DUKE.