Name:
First       Last       SS#  
Address:
Street


City State Zip
Phone    Email:
Father's Name: Occupation:
Mother's Name: Occupation:
Brothers & Sisters (ages) 
High School:  
Address: 		Phone:
High School Coach:     Phone:
Principal: Counselor: Phone:
Position: Off:     Def:     #:     40:
Ht:
 
Wt:
 		 Recognition Achieved in Football:
 
Do you have a definite are of study that you are going to pursue in college?  Yes  No
If yes, please indicate
Have you taken the ACT test? Yes  No  If yes, please list your scores. 
English Math Science Reasoning Reading
Composite
If no, when are you planning to take it?
What is your approx. GPA?   Class Rank? /  
Graduation Date    
Have you filed financial aid forms (FFS, FAF)?  Yes  No
Would you like more information concerning South Dakota Tech Academics and Football?
Yes  No
Do you know anyone who is attending or has attended SDSM&T? Yes  No
Additional information: