MSU-NORTHERN MEN

GENERAL INFORMATION

Name:

Age:

Birthdate: (MM/DD/YY)

Email Address:

Phone #:

Mailing Address:

City:

State:

Zip:

Spouse's Name:

Father's Name:

Occupation:

Father's Employer

Mother's Name:

Occupation:

Mother's Employer

SCHOOL INFORMATION

High school or Junior College:

Street:

City:

State:

Zip Code:

School Phone #:

Coach:

Coach's Phone:

Guidance Counselor:

ACADEMIC INFORMATION

Year in School:

Cumulative GPA:

Class Rank: (X out of Y)

Anticipated Graduation Date: (MM/DD/YY)

Taken the ACT/SAT?

Yes No

ACT/SAT Score:

Date Taken: (MM/DD/YY)

Anticipated College Major:

Anticipated College Minor:

ATHLETIC INFORMATION

Height:

Weight:

Position:

Scoring Average:

Rebound Average:

Assist Average:

Field Goal %:

Free Throw %:

3 Point FG %:

Athletic Injuries (if any):

Honors Received:

Video Tape Available?

Yes No

Montana State University-Northern
Athletic Department
(406) 265-3761 (Phone) | (406) 265-4129 (Fax)
Contact Us
www.msun.edu/athletics

Armory Gymnasium
Montana State University-Northern
300 W. 11th Street
Havre, MT 59501-7751