DICKINSON COLLEGE FOOTBALL

INFORMATION REQUEST FORM

If you would like more information about football at Dickinson,  please print out this form, complete it, and mail it to the address below.  Alternatively, e-mail the form as an attachment.
Name  ______________________________________ 
 		 Birthdate _____________
Address ________________________City ___________    State ________ Zip __________

Home phone number  (____)________________

Father __________________ Occupation _______________ College ______________

Mother _________________ Occupation _______________ College ______________

ACADEMIC INFORMATION
High School ____________________________________ Graduation Date _________

Address __________________________City ______________ State _______ Zip ______

PSAT ________SAT: V _______ M ________ GPA _______ Class Rank ____/_____

Scholastic Honors_________________________________________________________

Name of  Guidance Counselor _______________________

Academic Interests (1) _____________________  (2) _______________________

ATHLETIC INFORMATION
 
Height __________ Weight _________
 
 
Varsity Letters ______ Playing Position _______________
Athletic Honors ____________________________________________________________

Head Coach's Name _______________________School Telephone  (___)__________

Other sports played ______________________________________ 

GENERAL INFORMATION
Student Friends at Dickinson _______________________________________________

Have you previously contacted the Dickinson College Admissions Office?  _______
 
 
Please Return to:  
Darwin Breaux,  Head Football Coach
Dickinson College PO Box 1773, Carlisle, PA 17013
 
You may e-mail this form as an attachment to:  
breaux@dickinson.edu

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