Student-Athlete Information Form

Email Secondary Email

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Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Cell Phone Number *

Primary Sport at UM-Dearborn *

Additional Sports at UM-Dearborn

Twitter Handle

Instagram Handle

Upcoming year of athletic eligibility at UM-Dearborn *

Academic Class Standing as of upcoming Fall Term *

Major(s) at UM-Dearborn or write undecided *

Height *

Weight (Only for Men's Basketball, Men's Ice Hockey, Men's Lacrosse, Men's Soccer and Baseball)

Position

Handedness (Baseball, Softball, Ice Hockey)

Birthdate *

Date Picker

Mother's Name *

Father's Name *

Hometown *

High School (Full Name) *

Year of High School Graduation *

High School Mascot *

High School Coach's Name

Hometown Newspaper

High School Sport (Primary). Please list all years played, statistics, team and individual awards and achievements *

Additional High School Sports (Those not continuing at UM-Dearborn). Please list all sports played, years played, team and individual awards and achievements.

High School Academic Honors

Other Colleges Attended

List years played at other college, statistics, awards and achievements

Other Colleges Attended (Additional)

List years played at other college, statistics, awards and achievements (Additional)

* required field