Allen Community College

    
Personal Information

Name: 
      
(Last Name)              (First Name)             (age) (Date of Birth)

Social Security #   Gender: Male Female
 
Permanent Home Address:
        
(Number and Street)      (City)          (State)  (ZIP)        
  
Phone:          E-Mail:
  
(Day Phone)          

Parents: 
 
(Father)                 (Mother)           

Coach's Name:            Phone:
 


High School Information
  
  
High School: (from which you graduated or will graduate)
       

 Classification Size (ex. 4A)
                                        (Date of Graduation) 
  
Cumulative GPA:   SAT/ACT Scores (if taken): 

Academic Interests:


Sports Participating In:
  



Athletic Information
   
Event  Distance/Time  
Location/Date  

Event  Distance/Time  
Location/Date  
 
Event  Distance/Time  
Location/Date  
               

Interest Level

Please indicate the level of interest you currently have in attending ACCC. (Scale from 1 to 5, with 1 = slightly interested, 5 = will be attending)

Interest Level 1 2 3 4 5
Other Colleges I'm currently looking at

If you have any questions please contact:

Clinton Fletcher, Head Coach
(620) 365-5116 ext. 215 or email fletcher@allencc.edu

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