Prospective Athlete Request for Information

Please complete the following form in order to receive more information from Lourdes University Athletics.

*Indicates a Required Field

Personal Information

Student Email Address *

First Name *

Middle Name

Last Name *

Birthdate *

Student Mobile Phone number (xxx-xxx-xxxx)

Mailing Information

Mailing Address *

Country
Street
City
Region
Postal Code

Academic Information

Student Level

Are you a New or Transfer Student?*

What is your anticipated high school graduation year?

What semester would you like to enroll? Fall = August Start, Summer = May Start, Spring = January Start

What is your class rank?

What is your High School/College Grade Point Average (GPA)?

Academic Program of Interest

Search for your school *

School CEEB:

SAT Score

ACT Score

Do you plan to take the SAT or ACT again?

Yes

No

Athletic Information

Primary Sport(s) you are interested in*

Height

Weight

Letters Won in this Sport

HS Coach's Name

HS Coach's Phone

Club Team

Club Coach's Name

Club Coach's Phone

Position

Career Statistics (Include Personal Best)

All-Conference/other Honors/Team Highlights