North Carolina Wesleyan Athletics

ONLINE WOMen's CROSS COUNTRY Questionnaire

Please fill this questionnaire out completely. When completed, click the submit button
at the bottom to send the information to Head Coach Dominic Modise.

PERSONAL INFORMATION
Name:
Called Name:
Date of Birth:
Address:
City:
State:
Zip:
Class:
Height:
Weight:
Telephone Number:
Name of Parent:
Occupation:
Business Phone:
Name of Parent:
Occupation:
Business Phone:
NCWC Alumni You Know:
Student Friends at NCWC:

ACADEMIC INFORMATION
High School:
Address:
School Telephone:
Athletic Office Telephone:
Rank/Number In Class:
Overall Grade Point Average:
SAT Score:	Verbal
	Math
	Total
ACT Score:
Curriculum You Desire To Study - Intended Major/Minor:
Have You Applied to NCWC?
Have You Been Accepted?
Have You Completed The FAF?

ATHLETIC INFORMATION
High School Coach:
Address:
Coach's Home Telephone:
Best Running Time:
Individual Athletic Honors Won:
Other Sports You Play:
Team Honors Won:
Are Video Tapes Available?
Will You Send Us A Copy?
E-Mail address:
Comments

PLEASE FORWARD FALL/SPRING SCHEDULES IF AVAILABLE. THANK YOU FOR YOUR INTEREST IN OUR PROGRAM!

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