University of Texas at Dallas Cross Country
PROSPECTIVE STUDENT-ATHLETE QUESTIONNAIRE

If you are interested in playing highly-competitive intercollegiate athletics at a well-respected,
public university, please let us know about you by filling out the following questionnaire...

PRIVACY/SECURITY NOTICE
With few exceptions, you are entitled on your request to be informed about the information UT Dallas collects
about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive
and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have
UT Dallas correct information about you that is held by us and that is incorrect.

IMPORTANT! Please be aware that the information you about to submit
will be sent via email in an UNSECURED FORMAT, and that by sending
this information, you are granting UT-Dallas permission to collect this
information. If you are not comfortable sending any of this information in this manner, please just get in
touch with COACH BRANDON RAINS directly and we will send you a hard copy of the questionnaire.
Thanks for your interest in UT-Dallas!

PERSONAL INFORMATION
Name (First, Last)
Birthdate
Home Address
City, State
Zip
Year You Will Graduate
Home Phone
Other Phone
E-mail
SEX: MALE | FEMALE
I live with: Mom Dad Both Other
Father's Name
Mother's Name
Occupation
Occupation
Work Telephone
Work Telephone
Brother's and Sister's Names
Friends/Family currently at UTDallas

ACADEMIC INFORMATION
HIGH SCHOOL INFORMATION
High School Name
Location (City/State)
Grade Point Average (on 4.0 scale):
Class Rank : No. in Class:

ACT Test Score:

SAT COMBINED SCORE:  SAT Math: SAT Critical Reading:

School Main Office #
Counselor Office #
High School Coach's Name
Coach's Office Phone
Coach's Home Phone
Coach's Email Address
Other Coaching Reference Name
Other Coach Phone Number

Other Schools You Are Considering
Possible College Majors:
Academic Honors Won:
JUNIOR COLLEGE/COLLEGE INFORMATION (if applicable)
Current College/JUCO Name
City/State
College Coach 's Name
Coach's Office Phone
College Coach Other Phone (home/cell)
 College GPA:  Credit Hours: 
Is your current school aware of your plans to transfer? Yes No, please keep confidential

ATHLETIC INFORMATION
Height Weight  

YEARS PLAYED on H.S. Varsity?
YEARS PLAYED Collegiately?

  Height Weight

Best Time & Distance

 Date & Location Run

INDIVIDUAL ATHLETIC HONORS/ACCOMPLISHMENTS:

Names of Teammates or Other Players You Know Who Might Be Prospects

FORMMAIL © Copyright 1995 - 2002 Matthew M. Wright All Rights Reserved.

    

If this form does not appear to transmit correctly, please email COACH BRANDON RAINS directly.
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