Student-Athlete Interest Form
Brockport XC/Track & Field
BACKGROUND INFORMATION
First Name:
Last Name:
E-mail:
Home Phone:
Cell Phone:
Street:
Town:
State:
Zip Code:
Country:
Date of Birth (mm/dd/year):
Gender:
Height: ft inches
Weight (lbs):
Parent Names:
Mother: Job/College Attended:
Father: Job/College Attended:
ACADEMIC INFORMATION
Present School (HS or college):
Present Grade:
Present GPA (include scale):
Class Rank (include class size):
SAT Math:   SAT Critical Reading:
SAT Writing:
SAT Subject Test #1:  Score:
SAT Subject Test #2:  Score:
SAT Subject Test #3:  Score:
ACT:
ACT Math:
ACT English:
ACT Reading:
ACT Science:
Intended College Major:
College Choice #1:
College Choice #2:
College Choice #3:
What year would you attend Brockport?**
CROSS COUNTRY/TRACK & FIELD INFORMATION
Type of Track Athlete:
Do you run XC? YES  NO
Coach's Name:
Coach's Phone:
Coach's Email:
List Other Sports You Play:
SPRINTS JUMPS THROWS MID DIST DISTANCE XC
55m
 Long Jump
 Discus
 500m
 3000m
 2.5 mi
60m
 Triple Jump
 Shot Put
 600m
 3200m
 3.0 mi
100m
 High Jump
 Javelin
 800m
 2000m st
 5000m
200m
 Pole Vault
 Hammer Thw
 1000m
 3000m st
 8000m
300m
 MULTIS Weight Thw
 1200m
 5000m
 10000m
400m
 PENT
 1500m
 10000m
55m HH
 DEC
 1600m
60m IH
 HEP
 Mile
100m IH
110m IH
300m IH
400m IH
Comments For Coaching Staff: