Student-Athlete Interest Form
UMBC XC/Track & Field
BACKGROUND INFORMATION
First Name:
Last Name:
E-mail:
Home Phone:
Cell Phone:
Street:
Town:
State:
Maryland
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
UMBC
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Country:
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic
Cook Islands
Costa Rica
Côte d'Ivoire (Ivory Coast)
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
UMBC
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (north)
Korea (south)
Kuwait
Kyrgyzstan
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis and Futuna Islands
Western Sahara
Yemen
Zaire
Zambia
Zimbabwe
Date of Birth (mm/dd/year):
Gender:
Female
Male
Height:
ft 
inches
Weight (lbs):
Parent Names:
Mother: Job/College Attended:
Father: Job/College Attended:
ACADEMIC INFORMATION
Present School (HS or college):
Present Grade:
HS Freshman
HS Sophomore
HS Junior
HS Senior
Junior College
Transfer
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:
You will apply to UMBC as a:
Early Decision
Regular Decision
Undecided
What year would you attend UMBC?**
2008
2009
2010
2011
2012
CROSS COUNTRY/TRACK & FIELD INFORMATION
Type of Track Athlete:
Sprints
Jumps
Throws
Middle Distance
Distance
Multi-Events
Sprints/Jumps
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
400m
MULTIS
Weight Thw
1200m
5000m
10000m
55m HH
PENT
1500m
10000m
60m HH
DEC
1600m
100m IH
HEP
Mile
110m IH
300m IH
400m IH
Comments For Coaching Staff: