1. Name:  Year of Graduation: 
2. Date of Birth:  E-Mail:
   
3. Address: 
4. City:  State:  Zip: 
5. Home Phone: 
6. High School: 
7. Coach: 
8. Coach's Home Phone: 
9. Rank in Class:  PSAT Score: 
10. SAT(M):  SAT(V):  High School GPA: 
11. Desired College Major:
    
12. Personal Statistics:  
13. How would you rate your interest in Behrend?
    Top Choice:  Top 2-3-4?:  Possibly?: 
    Have you applied to Behrend?:  Do you plan to apply?: 
14. Additional Information: