PHOENIX COLLEGE TRACK AND FIELD QUESTIONNAIRE

PERSONAL DATA

Name __________________________________ E-mail: _______________________________

Social Security #: _________________________________

Address ____________________________________________________

City _____________________ State_________ Zip__________

Phone Number(s): ____________________________Fax: ______________________

Grad. Date ________ High School name _______________________

Year in School? ______________ G.P.A _______________

Parents Names: _______________________________________

High School Coach Names: ________________________ Phone: __________________

Will you qualify for financial aid? ________

A friend who may also be interested in our Track and Field Program: _____________________

Event Time/Hght/Dist Event Time/Hght/Dist

100/110 Hurdles ________________ Shot Put _____________

300/400 Hurdles ________________ Discus _____________

100 Meter Dash ________________ Javelin _____________

200 Meter Dash ________________ High Jump _____________

400 Meter Dash ________________ Long Jump _____________

800 Meter Dash ________________ Triple Jump _____________

1500 Meter _______________ Pole Vault ____________

Please fill this form out and return to Phoenix College Track and Field as soon as possible.

Fax to: (602) 285-7333.

For more information contact our office at (602) 285-7263.

Our mailing address: 1202 W. Thomas Rd. Phoenix, AZ 85013

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