Name:	Birth Date:
Mother's Name:	Father's Name:

Street Address:
City:	State:	Zip:

High School:	Home Phone:
High School Coach:	Cell Phone:
High School Coach's Phone Number:	Social Security Number:
High School Coach's E-mail Address:	Class (A-B-C-AA, etc.):

E-mail Address:

Overall GPA:

SAT:

ACT:

Your Academic Interests:

Parent's Occupation:

High School Wrestling Record:
	Freshman	Weight		Wins		Losses		State Place
	Sophomore	Weight		Wins		Losses		State Place
	Junior	Weight		Wins		Losses		State Place
	Senior	Weight		Wins		Losses		State Place

Cadet Nationals:
Year		Weight		Place FS		Place GR
Year		Weight		Place FS		Place GR

Junior Nationals:
Year		Weight		Place FS		Place GR
Year		Weight		Place FS		Place GR

What are your wrestling goals?