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* Name: (First, M.I., Last)
Street Address:
City:
State:
Zip:
Area Code & Phone (Optional):
* Email Address:
Birthdate: (MM/DD/YY)
High School Attended:
High School Phone:
High School Coach's Name:
High School GPA:
Guidance Counselor:
Year Graduated from High School:
Academic Area of Interest as GOCC:
Sport you are interested in at GOCC:
Letters won in Sports:
Position/Event:
Height/Weight: (6'2" - 145)