POWERLIFTING QUESTIONNAIRE

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First Name *

Middle Name *

Last Name *

Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Gender *

Male Female

Email address *

Cell Phone Number

Additional Phone

Date of Birth *

Parent/Guardian Name *

HIGH SCHOOL

High School Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

HIGH SCHOOL GPA

HIGH SCHOOL CLASS RANK

ACT SCORE

SAT SCORE

Do You Plan to Take Either Test Again

Yes No

IF YES, WHICH TEST AND WHEN?

Do You Plan to Seek Financial Aid?

Yes No

Have You Applied to Missouri Valley in the Past?

Yes No

INTENDED MAJOR

ACADEMIC HONORS/ACHIEVEMENTS

BESIDES POWERLIFTING, WHAT OTHER SPORTS DO YOU PARTICIPATE IN?

HEIGHT

WEIGHT

POWERLIFTING EXPERIENCE/HONORS/CAREER HIGHLIGHTS

Powerlifting Coach

Full Name

Coach's Phone

* required field