SALEM INTERNATIONAL UNIVERSITY – Cross Country

Please Complete and Return to:

Carl Hatfield - Men’s & Women’s Cross Country Coach

Salem International University

223 West Main St.

Salem, WV 26426

Recruiting Questionnaire

Name:______________________________________________________________________

Last First Middle

Mailing Address:________________________________________________________________

City:________________State/Prov.:____________Country:_________Postal Code:__________

Telephone:( )________________Email Address:__________________________________

High School:________________________________ Graduation Date:_____________________

High School Address:_____________________________________________________________

Junior College/College or University:______________________________ Semesters:_________

SSN___________________ D.O.B.___________ GPA___________ Class Rank_______________

SAT Scores: Verbal________ Math_________

ACT Scores: Eng.:______ Math:________ Reading________ Science_________ Comp:________

Are you registered with the NCAA Initial Eligibility Center (Clearinghouse)? (Y/N) ____________

Intended College Major:__________________________________________

Anticipated Start Date:____________________________________

Other Colleges that you are applying to:_____________________________________________

Parents/Guardians Names and Occupations:__________________________________________

__________________________________________

Number of Siblings (ages)_________________________________________________________

Cross Country Specific Information:

Ht:______ WT:_________

High School Cross Country Coach:______________________ Phone #____________________

Track / Running Club Coach:___________________________ Phone #____________________

How many years running? ______________________

Distance Performances

800 Meters __________

1600 Meters __________

3200 Meters __________

5K X-C ___________

OTHER ____________