Fields marked with * are mandatory
General

First Name *
*Please enter valid First Name
Last Name *
*Please enter valid Last Name
Email Address *
*Please enter valid Email Address
Home Address1 *
*Please enter valid Home Address1
Home Address2
*Please enter valid Home Address2
City *
*Please enter valid City
State *
*Please enter valid State
Zip *
*Please enter valid Zip
Home Phone Number
*Please enter valid Home Phone Number
Cell Phone Number
*Please enter valid Cell Phone Number
Graduation Year *
*Please enter valid Graduation Year
Position





*Please enter valid Position
Banner Number
*Please enter valid Banner Number
Are you a US Citizen?

*Please enter valid Are you a US Citizen?
Date of Birth *
*Please enter valid Date of Birth
Background

Mother's Name
*Please enter valid Mother's Name
Father's Name
*Please enter valid Father's Name
Have you applied?

*Please enter valid Have you applied?
Have you visited Brockport?

*Please enter valid Have you visited Brockport?
Date visited/would like to visit
*Please enter valid Date visited/would like to visit
Family members/friends who have attended Brockport
*Please enter valid Family members/friends who have attended Brockport
Athletic

Dominant Foot

*Please enter valid Dominant Foot
Height
FeetInch
*Please enter valid Height
Weight
*Please enter valid Weight
Athletic honors/awards
*Please enter valid Athletic honors/awards
Name of High School Coach
*Please enter valid Name of High School Coach
H.S. Coach's Phone
*Please enter valid H.S. Coach's Phone
H.S Coach's Email
*Please enter valid H.S Coach's Email
H.S Jersey #
*Please enter valid H.S Jersey #
Name of Club Team
*Please enter valid Name of Club Team
Name of Club Team Coach
*Please enter valid Name of Club Team Coach
Club Coach's Phone
*Please enter valid Club Coach's Phone
Club Coach's Email
*Please enter valid Club Coach's Email
Club's (or team's) website
*Please enter valid Club's (or team's) website
Club Team Jersey #
*Please enter valid Club Team Jersey #
Tournaments Club will participate in next 12 mo.
*Please enter valid Tournaments Club will participate in next 12 mo.
ODP Experience
*Please enter valid ODP Experience
Most recent year in ODP
*Please enter valid Most recent year in ODP
Other sports played
*Please enter valid Other sports played
Academic

High School/College
School Name
Address1
Address2
Address3
City
State
Zip
Country
CEEB Code
the school is not listed above
*Please enter valid High School/College
Class Rank
*Please enter valid Class Rank
GPA
*Please enter valid GPA
SAT Math
*Please enter valid SAT Math
SAT Verbal
*Please enter valid SAT Verbal
SAT Writing
*Please enter valid SAT Writing
SAT Total
*Please enter valid SAT Total
Date to take/retake SAT
*Please enter valid Date to take/retake SAT
ACT
*Please enter valid ACT
Academic Honors
*Please enter valid Academic Honors
Other College Choices
*Please enter valid Other College Choices
Intended Major
*Please enter valid Intended Major