Men's Track & Field/Cross Country Questionnaire
Personal Information
Name:
E-Mail Address:
Street Address:
City/Town:
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip:
Home Phone:
Cell Phone:
Date of Birth:
Social Security #:
Height:
Weight:
Father's Name:
Occupation:
Mother's Name:
Occupation:
Name of Brother(s):
Name of Sister(s):
Academic Information
High School:
School Address:
Graduation Date:
SAT scores:
Verbal:
Math:
Writing:
GPA:
Intended Major(s):
Have you registered with the NCAA Clearinghouse?
Yes
No
If you have registered, when?
Did you list Northeastern as one of the schools allowed access to your file?
Yes
No
If no, please see your guidance counselor immediately.
Athletics Information
Years Competing:
High School Coach:
Phone Number:
Years Competing - Club:
(if any)
Club Team:
Club Coach:
Phone Number:
Track Times:
55:
Two Mile:
400H:
100:
110H:
2K Steeple:
200:
300H:
3K Steeple:
400:
Cross Country:
800:
Course:
Time:
1500:
Course:
Time:
Mile:
Course:
Time:
Field Events:
High Jump:
Shot Put:
Pole Vault:
Discus:
Long Jump:
Javelin:
Triple Jump:
Hammer:
Other Sports:
Any other questions or comments:
