Austin Peay Cross Country and Track and Field Questionnaire
Austin Peay State University is a Division I program that competes in the Ohio Valley Conference. Please complete the following questionnaire if you have an interest in our program.

Required Fields in Bold
 
Personal Information
Full Name
 
Birth Date
 
Home Phone
 
Cell Phone
 
Email address
 
Permanent Address, City, State, Zip
 
Current Address, City, State, Zip
 
Father's Name
 
Father's Occupation
 
Did he attend college? Where?
 
Father's Home/Cell Phone Number
 
Mother's Name
 
Mother's Occupation
 
Did she attend college? Where?
 
Mother's Home/Cell Phone Number
 
 
Academic Information
High School
 
High School's Address
 
High School Phone Number
 
High School Counselor's Name
 
Graduation Date
 
Coach
 
Coach's Phone Number
 
Coach's Email Address
 
Class Rank
 
GPA
 
SAT/ACT Score
 
Anticipated Major/Field of Interest
 
Other schools you are considering
 
 
Athletic Information
Height and Weight
 
Average Weekly Mileage (Distance Runners)
 
Athletic Awards, Honors, Recognitions
 
 
Have you registered for the NCAA Clearinghouse?
 
Yes
No
If yes, what is your NCAA pin number?
 
Any past or current injuries?
 
Do you have any allergies or an asthmatic condition?
 
Do you wear orthodics?
 
Upcoming meeting information (Date, Meet or Race Name, Location, Event)
 
Please list your top four performances, including the meet and date they were performed.
 
Additional Comments or Questions
 
Track Club
 
Track Club
 
Track Club Coach
 
Club Coach's email address
 
Track Club Coach's Phone Number
 
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