Prospective athlete form



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202 South Halsted Street • Chicago Heights IL 60411
Phone:  708/709-3950 • Fax: 708/709-7770
e-mail: rfairbank@prairiestate.edu

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Department of Athletics & PE

Name:
Street:
City:
State:
Zipcode:
Home Phone:
Cell Phone:
Email: (required field)
High School :
GPA
Graduation Date:
Height: Weight: (optional)
   
Sport of Interest:
Baseball (M) Golf
(M) Basketball (M) Soccer
(W) Basketball Softball
(M) Cross Country (W) Volleyball
(W) Cross Country  
Additional information, statistics, honors, awards, etc.: