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Plymouth State Athletics Information Form 2013-14

Email address *
First name *
Last name *
Address 1 *
Address 2
City *
State *
ZIP Code *
Plymouth State ID # *
Today's Date *
PSU Sport(s): *
List all sports you plan to try out for
Common Name *
Used in press releases or when being introduced; i.e Thomas, Tom or Tommy; Susan, Sue, or Suzie, etc.
Gender *
Birth date *
Local Address *
(Residence Hall & Room Number or Street & Apt. Number)
HUB Suite #
PSU email address *
Secondary Email Address
Cell Phone # *
Local Phone Number
Parents/Guardian First and Last Names *
Parent/Guardian Address(es) *
(Street Address, City, State, Zip, Country (if not USA)
Parent Home Phone Number(s) *
Parents Cell Phone Number(s)
Emergency Contact *
(Name and Relationship)
Emergency Contact Phone Number *
Second Emergency Contact
(Name and Relationship)
Second Emergency Contact Phone Number
Academic Year *
Athletic Year *
(Number of years competing at collegiate level)
Height *
Daily Hometown Newspaper *
(Newspaper Name)
Daily Hometown Newspaper Location *
(City, State)
Weekly Hometown Newspaper
(Newspaper Name)
Weekly Hometown Newspaper Location
(City, State)
Are you a transfer student? *
(All 2-year and 4-year schools, including community colleges)
If Yes, Name all schools attended
(Name years and number of semesters attended for each school)
If Yes, Name all schools you participated in Athletics
(Name the sport and years played for each school)
High School *
High School location *
(City, State)
High School Graduation Year *
PSU Major(s) *
(Include Undeclared)
PSU Minor
Uniform Number Preference
(This does not guarantee getting a preferred Number)
Position in your sport
List any High School Athletic honors
* = required field