Athlete Information:

First Name: Last Name: Birth Date:

Email Address: Height: Weight:

Address:   ,

Home Phone: Cell Phone:

High School Coaches Information:

Coaches Full Name

Email Address: Phone:

Academic Information:

High School Name Grad Year:

High School Location: (city, state)

Cum. GPA: ACT Score: SAT Score:

Academic Interests:

Athletic Information:

Position/Specialties: Attack Midfield Face Off Specialist Defense Goalie Long Stick Middie

Years Played: Other Sports: (city, state)

Sports Honors/Awards:

Please tell us who initiated or what prompted your interest in our lacrosse program at Utah

Have you submitted your application to the University of Utah? Yes     No

If yes, have you been accepted yet? Yes     No

Do you have any questions or comments for our coaching staff?