LAST NAME: ________________________________________

FIRST NAME: _______________________________________

HOME ADDRESS: _________________________________________________________

CITY: ____________________________ STATE: ________ ZIP: ____________________

HOME PHONE: (_____)_____-___________ CELL PHONE: (____)_____-___________

EMAIL: ________________________________________________________

HIGH SCHOOL: _________________________________________________

HIGH SCHOOL HEAD COACH: ____________________________________

OFF POSITION: ___________ DEF POSITION: _______________

JERSEY NUMBER: _________ SPEC TEAMS (circle):   SN   PK   PUNT   RTN

HT: ________ WT: ________ 40 TIME: ________   CURRENT SCHOOL YEAR (circle):   SR   JR   SO   FR

DATE OF BIRTH: ___/___/____ ACT/SAT SCORE: _______ CLASS RANK: ___/___

2005 STATS: _________________________________________________________