Massachusetts Maritime Athletics Sports Information Questionnaire

Email address *

You are a candidate for what sport? *

Position: *

First Name *

Middle Name *

Last Name *

Class (Select One): Freshman (4/c); Sophomore (3/c); Junior (2/c); Senior (1/c) *

Major: *

Second Major/Minor: *

Height: *

Date of Birth: *

Place of Birth: *

Permanent Address: *

City: *

State: *

Zip Code: *

Cell Phone: *

Home Phone: *

Campus E-Mail Address: *

Other E-Mail Address: *

Father's Name: *

Mother's Name: *

Brothers & Sisters (List Names & Ages): *

Name of Daily Newspaper: *

Name of Weekly Newspaper: *

High School Attended: *

High School Graduation Year: *

If yes, what school did you transfer from? (If Any):

Please list all varsity sports, letters won, all star teams, statistics, awards, etc. PLEASE PROVIDE AS MUCH DETAIL AS POSSIBLE.

Freshman/9th Grade: *

Sophomore/10th Grade: *

Junior/11th Grade: *

Senior/12th Grade: *

Prep School/Other: *

High School/Prep School Academic Honors & Awards: *

Community Service Activities: *

Hobbies: *

Why did you choose to attend Massachusetts Maritime? *

PLEASE READ BEFORE SUBMITTING: Under the guidelines set forth by the Buckley Amendment , I understand that completion and signing of this questionnaire constitutes my permission to use any and all of this information for Massachusetts Maritime Academy Sports Information publicity purposes. I also understand that other information , both academic and athletic, will also be used for Massachusetts Maritime Academy Sports Information publicity purposes during my tenure as a student-athlete at the Academy.

Name (Electronic): *

Date of Submission: *

* required field