New Student-Athlete Questionnnaire 2013-14

(For student-athletes enrolled at Lyon College)

Name First Last
Your cell phone number - (###) - ### ####
Email
Hometown Newspaper
Hometown Newspaper Phone Number - (###) - ### ####
Hometown Newspaper's Sports Email Address
Classification at Lyon College Freshman Sophomore Junior Senior
Height
Sport(s) you will be competing in at Lyon College
Position(s) you will probably play
Anticipated Academic Major
Baseball/Softball Players: Bats
Baseball/Softball Players: Throws
PERSONAL INFORMATION
Date of Birth / MM / DD YYYY
Current Age
Social Security Number
College Address (Residence Hall & Room #; Also Include P.O. Box)

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
City of Birth
Sex
Your Home Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Place you want to appear as your hometown on roster and web site
Hobbies, Favorite Foods, Favorite Music or anything you might want added to your roster bio
Name of Family Physician
FAMILY INFORMATION
Father's Name
Father's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Father's Phone - (###) - ### ####
Father's Email Address
Mother's Name
Mother's Address/Information same as above?
Mother's address (if different from Father)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Mother's Phone (if different from Father) - (###) - ### ####
Mother's Email Address
Number of Brothers
Number of Sisters
Is your Father a graduate of Lyon College?
Is your Mother a graduate of Lyon College?
Do you have family members who are currently competing in college athletics? If so, list who, how related, what sport and where they are competing.
HIGH SCHOOL INFORMATION
High school graduated from
Year graduated
High school sports you participated in
Classification (size) of high school? Name/number of conference/district
High school mascot/nickname
High school academic honors earned
Activities outside athletics you were involved in at high school (clubs, organizations)
HIGH SCHOOL SPORTS YOU PARTICIPATED IN AND HONORS EARNED
Sport 1
Number of varsity letters earned in Sport 1
Sport 1 honors (all-district/all-conf.) and statistics (if available)
Sport 2
Number of varsity letters earned in Sport 2
Sport 2 honors (all-district/all-conf.) and statistics (if available)
Sport 3
Number of varsity letters earned in Sport 3
Sport 3 honors (all-district/all-conf.) and statistics (if available)
Sport 4
Number of varsity letters earned in Sport 4
Sport 4 honors (all-district/all-conf.) and statistics (if available)
Sport 5
Number of varsity letters earned in Sport 5
Sport 5 honors (all-district/all-conf.) and statistics (if available)
Give a brief rundown of your out-of-school sport experience, accomplishments, achievements and awards, such as traveling baseball/softball or summer basketball league or an international sport experience.
TRANSFERS
Previous school attended Number 1
Number of years of attendance at previous school Number 1
Sports competed in at previous school Number 1
Athletic and academic honors earned at previous school Number 1
Previous school attended Number 2
Number of years of attendance at previous school Number 2
Sports competed in at previous school Number 2
Athletic and academic honors earned at previous school Number 2
Previous school attended Number 3
Number of years of attendance at previous school Number 3
Athletic and academic honors earned at previous school Number 3
SPORTS INFORMATION
Under the Family Education and Privacy Act of1974, I authorize the Lyon College sports information office to disseminate any information provided on this form and in my educational records to media and other parties for the use in official College publications, news releases, nominations, web site and other sport information purposes.
By entering my name and date below, I am signing my electronic signature and give the sports information office permission to disseminate information of this form for official college purposes.
Name First Last
Today's Date / MM / DD YYYY