First Name:

	Last Name:

	Email Address:

	Home Address 1:

	Home Address 2:

	City:

	State:

	Zip:

	Country:

	Contact Number:

	Cell Phone Number:

	Date of Birth (mm/dd/yyyy):

	Mother's Name:

	Mother's Phone:

	Mother's Occupation:

	Father's Name:

	Father's Phone:

	Father's Occupation:

	Siblings:

	Graduation Year:

	High School Name:

	Address 1:

	Address 2:

	Address 3:

	City:

	State:

	Zip:

	Country:

	Counselor's Name:

	Counselor's Phone:

	Counselor's Email:

	Class Rank:

	GPA:

	SAT Math:

	SAT Critical Reading:

	SAT Writing:

	SAT Total:

	Probable Test Date If Not Taken:

	PSAT:

	ACT:

	TOEFL:

	Academic Honors:

	Intended Major:

	Other College Choices:

	Academic Goals:

	List any Honors, AP or IB courses you have taken:

	Are your results listed in NJGS or AJGA?

	Additional Results (Event/Yardage/Score):

	Home Course:

	City, State:

	Phone Number:

	Golf Teacher:

	Cell Phone Number:

	Email Address:

	Other Reference (non-family member):

	Relationship:

	Cell Phone Number:

	Athletic Goals and Aspirations:

	Do you have a swing video available?

	How can we attain it (VI/Youtube/CD/DVD)?