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Student-Athlete Request Form

Cougar Ruler

Thank you for your interest in SIUE. Please fill out the form and click on the submit button at the bottom.

Name
First     M.I.     Last     Suffix (Jr., Sr., etc.)

Social Security Number

(Optional- providing this number will ensure that we don't duplicate your record in our database.)		 Date of Birth
Mo.  Date  Year
E-mail Height
Weight
Address
City State ZIP Code Country Telephone
Mother's Name Father's Name
Name of High School or Junior College
School Address
City State ZIP Code Telephone
Coach's Name Telephone
Best Performance In:
100 meters Shot Put High Hurdles
200 meters Discus Low Hurdles
400 meters High Jump Javelin
800 Meters Long Jump Hammer/Weight
1500 Meters Triple Jump 5,000 meters
Mile Pole Vault 10,000 Meters
3,200 Meters Heptathlon Decathlon
Cross Country Only:
Best Cross Country Time Distance Name of Meet
Multi-Sport Athletes: Please List Other Sports
1.   2.  
ACT Score SAT Score Class Rank Grade Point Ave.
 
References regarding playing ability:
(include Name, Relationship to you, and phone number)
Term in which you intend to enter SIUE
Fall Semester   Spring Semester Summer Session    Year:

Do you plan to live on campus?      Yes      No      Undecided
If yes, click Housing Application   Single    Family 
 
Athletic Accomplishments

  
Transfer Information (how to transfer from another college)
 
Information about the following area of study:
(To choose up to 2 areas of study, hold down the Ctrl key while clicking)

Questions or comments? Send us an e-mail or call our Admission Counselors at 1-800-447-SIUE or (618) 650-3705.
Have you registered with the NCAA Clearinghouse?     Yes      No     Don't Know

For more information...
Undergraduate Catalog
Our Financial Aid Web site
Quicklinks for Students
Online Tour
Application for Admission to SIUE
Please double-check your entries to make sure they are correct. After you have pressed the submit button, please give the server a few seconds to process your request.

URL: www.siue.edu/ATHLETIC/MTCC/form.html
Published by: SIUE Sports Information
Last update: September 3, 2004 by ehess@siue.edu