Loras College Prospective Student Athlete - Wrestling


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 Wrestling:

Weight Class:          Number Of Years On Varsity:
Varsity Record:

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***

 
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1450 Alta Vista St., Dubuque, IA 52001 (800) 245-6727 (563) 588-7100