Thank you for taking the time to fill out this form. If you are unsure about an answer or the question does not apply to you, please leave that field blank. If you are interested in more than one sport, please fill out a separate form for those sports.

Please complete and submit this form or print it out and fax it to 717-948-6777 or mail to:

Rahsaan Carlton, Athletic Director
Athletic Department
Penn State Harrisburg
115 Capital Union Building
777 W. Harrisburg Pike
Middletown, PA 17057

Sport in which you are interested:

Men's Sports: Women's Sports: Men's and Women's Sports:
Men’s Basketball Women’s Soccer Tennis
Men’s Baseball Women’s Basketball Golf
Men’s Soccer Women’s Softball Cross Country
  Women’s Volleyball Cheerleading (Club)

Personal Information

Name:
Address:
City:
State/Prov:
Zip:
Country:
Phone Number: (###)###-####
E-mail:

Academic Information

I plan to apply to Penn State Harrisburg for:

Fall Semester Spring Semester Year:
High School:
Year of Graduation:
ACT Score:
SAT Score (Verbal):
SAT Score (Math):
GPA: On a scale of:
Academic Honors

Athletic Information

Height (ft-in):
Weight:
Number of Years Varsity:
High School Coach:

Position(s) you play:

Other Sports:

Athletic Achievements or Awards:

League/Club Name:
Coach:

Up-To-Date Stats:

Other:

What part of your career do these stats cover?

Transfer Students Only Complete this Portion

College:
City:
State/Prov:
Degree:
Two Year Degree:       Four Year Degree:
Date you first attended college: MM-YY
Credit Hours Earned:
GPA:

Do you or did you play on a college team?

Other:

Other Comments :