Loras College Catholic Liberal Arts

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Loras College Prospective Student Athlete - Men's Cross Country

Full Name: Today's Date:

Home Address:
Street Address:
City: State: Zip:

Home Phone: Email Address:

Date of Birth: Social Security # (optional):

Father's Name: Occupation:

Mother's Name: Occupation:

Have any members of your family attended Loras?	Yes
	No

If so, who and when?

Do you know anyone (classmate, neighbor, family, friend) who has attended Loras?

Yes
No

If so, who and when?

What other colleges are you interested in?

High School: High School Conference:

High School Address:

Guidance Counselor:

ACT or SAT Score: GPA: on a scale of: Graduation Year:

Academic honors you have received:

High School Coach: Coach's Phone:

Are You a Transfer Student?	Yes	If yes, what school?
	No

Coach at your previous college/JC: Coach's Phone:

How interested are you in Loras?	Very	Moderately
	Not Interested	Need More Info

Intended Major In College:

Honors In Cross Country or Track:

Best Cross Country Race: Date Distance Time

List Track Events And Your Personal Best Times:

State Qualifier?	Yes
	No

If Yes, What Was Your Time And The Distance?

Other High School Sports:

Honors In Those Sports:

THE FOLLOWING ITEMS ARE COMPLETELY OPTIONAL...

Your Religious Preference (optional):

Please Indicate your ethnic origin (optional):

White/Non-Hispanic	African American/Non-Hispanic
Hispanic	Native American/Native Alaskan
Native Asian/Pacific Islander	Other (please specify)

***CLICK SUBMIT ONCE ALL INFORMATION IS CORRECT, AND COMPLETED FORM WILL BE SENT TO THE RESPECTIVE COACH***