Personal Data:
Student Name
________________________________________________
Address
_____________________________________________________
City, State, and Zip
Code________________________________________
Phone Number
________________________________________________
High School
__________________________________________________
(To be filled in by judge)
Non-Weighted GPA: __________ _____
Athletic Participation __________(total number) _____
(Total Conference and Non-conference Activities)
On a separate sheet of paper please list the sports in which you have participated and the years of the participation.
Class Rank and students in class __________ _____
Total number of School Awards, Honors,
Records (Captain,
SVC/SIA Sponsored Activities: __________(number of activities) _____
Total All Years (Athletic Teams, Scholastic Bowl, Honor Chorus, etc.)
On a separate sheet of paper please list all the Conference activities in which you have participated and the years of the participation.
General School Activities __________(number of activities) _____
Total All Years (musical, plays, tutoring, Honor Society, etc.) On a separate sheet of paper please list all the general school activities in which you have participated and the years of the participation.
Two Teacher and/or Coach Recommendation Letters _____ _____
Principal’s
Verification Signature _________________________________
Total Possible Points 70 points Total Points Earned ____________