UNIVERSITY OF MASSACHUSETTS-DARTMOUTH
LACROSSE

PERSONAL INFORMATION

FIRST NAME  
LAST NAME  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
EMAIL  
DATE OF BIRTH  
MOTHER'S FIRST NAME  
MOTHER'S LAST NAME  
MOTHER'S EMAIL  
MOTHER'S WORK PHONE  
MOTHER'S CELL  
MOTHER'S ALMA MATER  
MOTHER'S OCCUPATION  
FATHER'S FIRST NAME  
FATHER'S LAST NAME  
FATHER'S EMAIL  
FATHER'S WORK PHONE  
FATHER'S CELL  
FATHER'S ALMA MATER  
FATHER'S OCCUPATION  
SIBLINGS  
OTHER SCHOOLS INTERESTED  
ARE YOU REGISTERED WITH THE ELIGIBILITY CENTER?  
IF YES, WHAT IS YOUR ELIGIBILITY CENTER ID?  
HAVE YOU VISITED CAMPUS?  

ACADEMIC INFORMATION

GRADUATION YEAR  
HS NAME  

HS ADDRESS  
 
HS CITY  
HS STATE  
ZIP  
HS PHONE  
CLASS RANK  
GRADE POINT AVERAGE  
ACT  
SAT TOTAL  
INTENDED MAJOR  

ATHLETIC INFORMATION

HS COACH'S FIRST NAME  
HS COACH'S LAST NAME  
HS COACH'S EMAIL  
HS COACH'S CELL PHONE  
HS COACH'S WORK PHONE  
POSITION  
HEIGHT  
WEIGHT  
JERSEY NO  
ATHLETIC HONORS  
OTHER SPORTS PLAYED  
ONLINE VIDEO LINK  
 

CLUB TEAM

CLUB TEAM NAME  
2013 SUMMER EVENTS ATTENDING  
CLUB COACH'S FIRST NAME  
CLUB COACH'S LAST NAME  
CLUB COACH'S EMAIL  
CLUB COACH'S CELL PHONE  
PLEASE CERTIFY THAT YOU ARE A HIGH SCHOOL JUNIOR OR SENIOR, OR ARE A CURRENT COLLEGE STUDENT   Yes, it is AFTER September 1st of my Junior year of high school.
No, it is BEFORE September 1st of my Junior year of high school.