Pitt State Track & Field/Cross Country
Prospective Student-Athlete Questionnaire
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Personal Information
First Name *
Last Name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Email *
Home phone (include area code)
Cell Phone *
Address *
City *
State *
Zip *
Country
Father/Guardian's Name
Father/Guardian's Occupation
Mother/Guardian's Name
Mother/Guardian's Occupation
Academic Information
High School Attended *
High School Graduation Year *
High School Address
City & State
High School Coach's Name
Coach's Email address
High School GPA
High School Class Rank
Example: 26 out of 85
ACT Composite Score
ACT Sum Score
(Add all four Sub Scores together)
SAT Score
Math & Verbal Total
Anticipated Major
Junior College/4-year Colloege attended
Have you applied to the NCAA Eligibility Center?
Eligibility Center ID#
Athletic Information and Performances
Height *
Weight *
Years Participated in Track
Event #1
Event *
Best Mark *
Location
Date
MM
/
DD
/
YYYY
Event #2
Event
Best Mark
Location
Date
MM
/
DD
/
YYYY
Event #3
Event
Best Mark
Location
Date
MM
/
DD
/
YYYY
Event #4
Event
Best Mark
Location
Date
MM
/
DD
/
YYYY
Video and Web Links
Competition or Practice Video
Online Recruiting Profile
FaceBook
Paste the URL from your Facebook profile
Twitter
Instagram
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