Clark State - Athletics Interest Form

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Athletics - Go Eagles!

Please complete the form below if you are interested in athletics at Clark State. All information will be maintained in a confidential manner and used solely by the College.

Full Name:
Street:

City:
State:
Zip Code:
Telephone:
E-mail:
Gender:	Male Female
Preferred method of contact:	Telephone E-mail
Date of Birth:
High School:
High School Coach:
Phone Number of High School Coach:
High School Graduation Date:
Sport of Interest:
Varsity Experience (years):
Height:
Weight:
Position:
Major/Field You Want to Study:
Any additional information, statistics, honors, awards, etc.: