Prospective cheerleader form

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

Name:
Street:
City:
State:
Zipcode:
Home Phone:
Cell Phone:
Date of Birth:
High School :
Name of H.S. Coach
GPA
ACT Score
SAT Score
Graduation Date:
College Major:
Height:	Weight: (optional)
Male/Female
Email: (required field)
Additional information, statistics, honors, awards, etc.:

After you click "submit" you will be directed back to this page. It is not necessary to click "submit" again. Thank you.