Freshman Student-Athlete Questionaire
Please be advised that the following information is necessary in order to determine your eligibilty for participation.

In State (New York)      Out of State     Foreign (Student Visa) 

Sport(s): 
               
               
Do you have a videotape available for the coach's viewing?  Yes    No 

Personal Information
Full Name: 
Address:    
City:     State:    
Zip:  
Home Phone:     
Cell Phone:        
E-Mail Address: 
Height:           
Weight:          
Date of Birth: 
Social Security Number (necessary in order to access your information at the NCAA Eligibilty Center):          

Parent/Guardian Information
Parent/Guardian Name: 
                                      
Parent/Guardian Address (if different than above) : 
City:     State:    
Zip:  
Parent/Guardian Phone: 

High School Information
High School:                
High School Address: 
City:     State:    
Zip:   
Graduation date / expected date of graduation: 
Type of Degree earned:    Diploma     Other (Please List) 
If applicable, date GED was received: 
High School GPA / AVG (weighted): 

If applicable, please list any years when you were not enrolled in High School:
From        to   
Reason 
From        to 
Reason 
From        to 
Reason 
From        to 
Reason 
Did you begin any semester and withdraw?  Yes    No 
If yes, please list school name: 
Year and semester: 

Test Scores
SAT Math:    SAT Critical Reading:    
SAT Writing: 
SAT Date Taken: 

ACT Math:    ACT Verbal:   
ACT Date Taken: 

TOEFL Score (Foreign Students Only): 

Additional Information
Have you filed with the NCAA Eligibilty Center?  Yes     No 
If no, please visit the following website in order to register:
https://web1.ncaa.org/eligibilitycenter/common/
If yes, what is your Clearing House ID #?
If yes, what is your Amateur Decision Status?  Certified     Not Certified 
Have you applied to Queens College?  Yes     No 
Term you plan to begin college: 
Year you plan to begin college:  
Intended major: 

If not a US citizen, please list country of citizenship: 
Type of Visa: 

I certify that, to the best of my knowledge, the information I have provided is complete and correct.
  Date
Please type name above. This will serve as your electronic signature.

Please submit electronically by clicking below:



If you are unable to submit electronically, please print and send to:
Merlin Thompson
Athleic Department
Queens College
65-30 Kissena Blvd.
Flushing, NY 11367-1597