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Submit by Email

First Name_______________________________

Print Form

Last Name_____________________________

Date of Birth____________________________________________________ Mailing Address______________________________ State________________________

City_______________________________________

Zip Code_____________________

Home Phone________________________

Country_____________________

Cell Phone_______________________

E-Mail Address________________________________________________________________ High School Graduation Date: Month_____________________

Year___________________________

High School Name_______________________________________________________ High School Location (City)___________________________________________________ High School Location (State)_____________________________________________ High School GPA_________________________________ High School ACT/SAT Score________________________________ College Attended___________________________________________________ College Location (City)______________________________________________ College Location (State)____________________________________________ College GPA_____________________________ Intended Entry Term

Year_______________________________________

Intended Major____________________________________________________________


Athletic Information

Weight Class_______________________________ High School Record___________________________ Junior College Record____________________________ High School Accomplishments (All State, All conference, etc)

Junior College Accomplishments (All State, All conference, etc)


http://www.dickinsonstate.edu/pdf/athletics/WrestlingProspectiveFormSubmit