The completion of this questionnaire does not commit you or North Carolina
A&T State University.                                  

First  Name   Middle Initial         

Last Name  

Address       
                   

City        
State      Zip

Home Phone        
E-Mail Address       
DOB      Age      

Grade (Current)     
Year of Graduation  

Father's Name    
Occupation      

Father's College
Mother's College

Mother's Name       
Occupation       

'Siblings' Name
Siblings' College

Choose one:
I live with my mother/father/both/other
If you live with someone other than your parents, what is this person(s) name

Overall GPA     Core GPA         Class Rank  
Junior College GPA

Guidance Counselor's Name       
SAT (Math/Verbal/Total)     ACT  

Guidance Counselor's Phone  

Registered with NCAA Clearinghouse (Yes/No)  
PID #  

What college majors interest you?

High School/Junior College       

Address       
                   

City                   
State          Zip

Coach's Name

Coach's Office Phone           

Coach's College
Coach's Home Phone
 

Principal's Name

List any friends or relatives who are alumni of North Carolina A&T State University

List your top five college choices in order       
List any injuries, the severity and whether surgery was involved 
    
Who is your favorite NFL Player          

Football Miscellaneous

High School or Junior College jersey #    Position   Height  
Weight 40 Time    Vertical    Shoe Size

Athletic Awards/Honors