QUESTIONNAIRE
Please complete the following form with all available information. Hit the SUBMIT button at the bottom to electronically submit. If submitting an application by mail, please type or print all answers and mail to address listed at the bottom.
PERSONAL DATA
Legal Name: Last First Middle Initial Marital Status: Email Address: Date of Birth: Mailing Address: Street City State Zip Home Phone: Cell Phone:
WRESTLING DATA
Height: Natural Weight: High School Records: Freshman Sophomore Junior Senior
State Place or Qualifier: Freshman Sophomore Junior Senior
High School Weight Class: Freshman Sophomore Junior Senior Other Sports Participated in and number of years in each: Name of your current head coach: Home Phone: Office Phone: Coach's Email Address: Athletic honors received:
SCHOLASTIC DATA
Name of your High School: School Address: Street City State Zip Cumulative Grade Point: Class Rank: ACT Score: (if available) Graduation Date and Year: School Phone: Have you filed the Family Financial Statement Packet: Yes No Date Filed: EFC#: Counselor's Name: Academic Interest Area(s):
FAMILY DATA
Mother's Name: Address: Street City State Zip Telephone #:
Father's Name: Address: Street City State Zip Telephone #:
Brothers & Sisters: (Names & Ages)
Marital Status of Your Parents Married Separated Divorced Deceased
Name/Signature: Date:
You may choose to submit this application electronically, or by mail, to: Wrestling Office 300 South 18th Street Estherville, IA 51334-2725
Copyright © 1996 - 2008 by Iowa Lakes Community College. All rights reserved. Campuses in Algona, Emmetsburg, Estherville, Spencer and Spirit Lake. If you would like us to mail you information, please complete this request form. Questions or comments? Please email us at info@iowalakes.edu or call (712) 362-2604 or 1-800-521-5054. Equal Opportunity Statement
