Today's Date: Date of Birth:

Last Name: First: Middle:

Mailing Address:

City: State: Zip/Postal Code:

Country: E-mail address:

Home Phone Number: Cell Phone Number:

Father:
Occupation: Alma Mater:

Mother:
Occupation: Alma Mater:

Relatives or friends who are attending, or have attended, Augsburg?

Term and Year of Entry to Augsburg (check one and add year of entry): Fall 20 Spring 20

Entering Augsburg as a (check one): Freshman Transfer Special International PSEOA Physician Assistant

Positions Played:

Shot: Height: Jersey Number:

Amateur Teams Played (list team and league):

Amateur Coach: Phone:
Coach's E-mail:

Amateur Team Awards/Honors:

Last High School Attended:

High School Coach: Phone:
Coach's E-mail:

Year of Graduation: Grade-Point Average: High School Class Rank:

Test Score (check if taken): ACT PSAT SAT

List any high school awards and honors (team captain, team MVP, all-conference, all-state, academic all-state, etc.) received, and any other information you think our coaches should know:

Other High School Sports/Activities:
(Music, Theatre, Student Government, etc., please be as specific as you would like.)

Last College Attended (if transferring):

College Coach: Phone:
Coach's E-mail:

Year of Graduation: Grade-Point Average:

Major: College Degree Obtained:

List any college awards and honors (team captain, team MVP, all-conference, All-America, academic awards, etc.) received, and any other information you think our coaches should know:

Other College Sports/Activities:
(Music, Theatre, Student Government, etc., please be as specific as you would like.)

Academic/career interests and hobbies:

Proposed major:

Other sports interested in playing at Augsburg:

Other colleges under consideration:

What are your goals to be achieved in the next five years?

I would like to (check all that apply): Schedule a campus visit Be contacted by a coach Receive an application

Type your questions or comments here: