Name:      Date:
Street Address:    Cell Phone:
City:   State:   Zip:   SSN:
High School Wrestling Weight:  Expected College Wrestling Weight: Birth date:
Parent or Guardian:   
Occupation:        Home Phone:
Street Address:
City:        State:                             Zip:       
High School:   Graduation Year:
High School Coach:    Phone: 
Approx. GPA in High School:     Expected Major:
All Time Record:  Wins    Loses
How interested are you in attending LCC: Very Somewhat Not Sure
Email Address:
Special Honors In Wrestling:     
Summer Wrestling (List Tournaments and Placing):