| Personal Information |
| First Name |
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| Middle Name |
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| Last name |
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| Preferred |
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| Birth date |
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| E-mail Address |
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| Address |
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| City |
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| State |
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| Zip |
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| Home Phone |
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| Cell Phone |
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| |
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| Father's Name |
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| Occupation |
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| Alma Mater |
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| |
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| Mother's Name |
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| Occupation |
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| Alma Mater |
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| Parents are |
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| I live with |
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| Siblings (Age/Alma Mater) |
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Scholastic Information |
| School |
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| School Phone |
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| School Address |
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| City |
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| State |
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| Zip |
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| |
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| Counselor's Name |
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| College Major |
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| GPA |
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| Class Rank |
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| Year of Graduation |
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| PSAT |
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| SAT I Verbal |
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| SAT I Math |
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| ACT Composite |
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| Will you apply for Financial Aid? |
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| Who will you look to for advice about your college decision? |
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| Do you know any LaGrange College Students/Alumni? |
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If so, who? |
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| Football Information |
| Ht. |
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| Wt. |
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| 40 time |
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| Starting Pos. |
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| Other Pos. |
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| Jersey # and Color |
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| Snapper |
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| Returner |
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| Other Sports and positions played |
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| Coach |
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| Home Phone |
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| Athletic accomplishments |
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| Release |
| By submitting this form I hereby authorize the release of my academic transcript to LaGrange College |
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