Lakeland College Cross Country and Track Inquiry Form

Name:
Address:
City:
County:
State:
Zip:
Date of Birth (month/day/year):
High School:
Year of Graduation:
Home Phone:
Cell Phone:
E-mail Address:
Height:
Weight:
Gender:
Please indicate whether you are interested in track, cross country, or both:
How long have you competed in track & field?
How long have you competed in cross-country?
Event #1: Name of event:
Best mark or time:
Event #2: Name of event:
Best mark or time:
Event #3: Name of event:
Best mark or time:
Please list any honors that you have won:
Coach:
Coach's Office Phone No:
Coach's Cell Phone No:
Coach's Email:
Other athletes that may be interested in participating in Lakeland's track & field or cross country programs: Name:
Phone:
Name:
Phone:
High School GPA (overall): on a -point scale.
Composite ACT Score:
Composite SAT Score:
Academic Interest #1:
Academic Interest #2: