Lake Superior State University

Cross Country / Track and Field Questionnaire

Thank you for your interest in Lake Superior State University cross country and track. By completing
this questionnaire, you are indicating an interest in competing on the Laker Cross Country and/or Track
and Field team. This form in no way binds you to LSSU or to any agreement.
Please complete, refold and tape with business reply showing.

PERSONAL INFORMATION

Name________________________________________ Phone _____________________________________

Home Address ________________________________ City _______________________________________
State ____________________ Zip ________________ E-Mail Address ______________________________
County __________________ Birthdate ___________ Social Security ______________________________
Father’s Name ________________________________ Occupation_________________________________
Mother’s Name________________________________ Occupation_________________________________
Names and Ages of Siblings_________________________________________________________________

ACADEMIC INFORMATION

High School __________________________________ Address/City ________________________________

H.S. Counselor ________________________________ Year of Graduation __________________________
GPA ____________________ Class Rank/Size ___________________ ACT(Sum)/SAT _________________
Intended Area of Study_____________________________________________________________________
Academic Honors _________________________________________________________________________

ATHLETIC INFORMATION

Event(s) Fr. So. Jr. Sr. Collegiate Goal

Example: 400 60.00 59.25 58.75 ??? 56.00
1
2
3
4

Height ______________ Weight (optional) _________ Years Participated _________________________

Other Athletic Interests _____________________________________________________________________
Serious Injuries? Is yes, describe _____________________________________________________________
_________________________________________________________________________________________
Other colleges you are considering __________________________________________________________
Have you registered for the NCAA Clearinghouse NO____ YES_____ PIN # ____________________
(If No...ask your Guidance Counselor)

650 W. Easterday Avenue • Sault Ste. Marie, MI 49783

Head Coach: Steve Eles 906-635-2765 • Fax 906-635-2753
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POSTAGE WILL BE PAID BY ADDRESSEE

Track & Field / Cross Country

Lake Superior State University
650 W Easterday Avenue
Sault Ste Marie MI 49783

Attention: Juniors and Seniors

Cross Country
Track & Field
State University
Lake Superior

Sault Ste. Marie, MI 49783

650 W. Easterday Avenue
Lake Superior State University
Track & Field / Cross Country