Prospective Student/ Athlete Questionnaire
Personal Information
Name:	(Last) , (First) (Middle)
Gender:	Male Female	Date of birth:	(mm/dd/yyyy)
Email:		Home phone:
		Cell phone:
Home address:	(Street) (City) (State) AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMariana IslandsMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon TerritoryAPO ZIP's 090-098APO ZIP's 340APO ZIP's 962-966 (ZIP)
Height:		Weight:	(Men only)
Father:		Occupation:
Email:		Work phone:
Mother:		Occupation:
Email:		Work phone:
Siblings at home:		Siblings in college:
List any relatives or friends associated with Azusa Pacific:
Academic Information
High school:		Graduation date:
Address:	(Street) (City) (State) AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMariana IslandsMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon TerritoryAPO ZIP's 090-098APO ZIP's 340APO ZIP's 962-966 (ZIP)
Grade-point average:		Anticipated major:	UndecidedAccountingApplied HealthArtAthletic TrainingBiblical StudiesBiochemistryBiologyBusiness AdministrationBusiness EconomicsChemistryChristian MinistriesCinema and Broadcast ArtsCommunication StudiesComputer Information SystemsComputer ScienceEconomicsEnglishFinanceGlobal StudiesGraphic DesignHistoryInternational BusinessJournalismMarketingMath/PhysicsMathematicsMusicNursingPerformancePhilosophyPhysical EducationPhysicsPolitical SciencePre-Allied Health and PharmacyPre-EngineeringPre-LawPredental/PremedicalPsychologySocial ScienceSocial WorkSociologySpanishTeachingTheater ArtsTheologyYouth Ministry
Previous colleges (junior college and four year):
Address:	(Street) (City) (State) AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMariana IslandsMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon TerritoryAPO ZIP's 090-098APO ZIP's 340APO ZIP's 962-966 (ZIP)
Previous colleges (junior college and four year):
Address:	(Street) (City) (State) AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMariana IslandsMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon TerritoryAPO ZIP's 090-098APO ZIP's 340APO ZIP's 962-966 (ZIP)
SAT:	(Verbal) (Math)	ACT:
Class rank:	/
Academic awards:

Track & Field-Specific Questions
Events		Personal Record (year)
Sprints
Distance
Cross Country or Track
Jumps
Throws
Multi-Events
Relays
Split
International/Local Club Affiliation: