General Information

Name: First:________________________________________________ Last: _______________________________________________

Cell Phone Number:________________________________Home Number:____________________________________________

Home Address:__________________________________________________________________________________________________

City:____________________________________State:_________________________________ Zip:_____________________________

E-mail Address:__________________________________________________________________________________________________

High School:_____________________________________________________________________________________________________

Head Coach:________________________________________ Contact Number:_________________________________________

Previous College:________________________________________________________________________________________________

Head Coach:___________________________________________ Contact Number:_______________________________________

Academic Information

Guidance Counselor/Academic Advisor:_______________________________________________________________________

Intrested Course od Studey:_____________________________________________________________________________________

GPA (4.0 System):___________________  SAT Score:_______________  ACT Score:_______________

Graduation Date:_______________________________

Volleyball Information

Height:____________ Dominant Hand:___________Right___________Left

Standing Reach:________________  Jump Touch:___________________

Position(s) Played:_______________________________________________________________________________________________

Do you have a video of your game(s)? _____________Yes_______________No

Please Return This Form or Fax it to (863) 297-1066
Ruth Ann Rogers, Head Coach
Office Phone: (863) 297-1000
Athletic Office
Polk State College
999 Avenue H, NE 
Winter Haven, Florida 33881