Women's Cross Country Recruiting Form

Join Our Team

1) Fill out the web form. We will contact you upon review.
2) E-mail or mail the following items to Jason Rose, Head Coach:

• an game schedule, newspaper clippings, and/or
• game video if they are available

Jason Rose, Head Coach
1600 Burrstone Rd.
Utica, NY 13502

Thank you for your inquiry. We appreciate your interest in Utica College!

Personal Information
First Name *
Last Name *
Current Address
City
State	-- Choose a State -- Alabama Alaska Alberta American Samoa Arizona Arkansas Australian Capitol Territory British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Foreign State Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Military - Americas Military - Europe Military - Pacific Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales New York Newfoundland Newfoundland and Labrador Norfolk Island North Carolina North Dakota Northern Mariana Islands Northern Territory Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Provence of Quebec Puerto Rico Quebec Queensland Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania Tennessee Texas Utah Vermont Victoria Virgin Islands Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon Territory
Zip Code
Home Phone
Cell Phone
E-mail Address
Date of Birth	(mm/dd/yyyy)
Father/Guardian
Mother/Guardian
Academic Information
High School/Junior College
Year of HS/JC Graduation
GPA/Class Rank
PSAT or SAT Scores	(Verbal and math)
ACT Score
Majors of Interest	-- Choose Majors of Interest -- Accounting Accounting - CPA Biochemistry Biology Business Business Economics Chemistry Child Life Communication Communication Arts Computer Science Construction Management Criminal Justice Criminal Justice - Economic Crime Investigation Cybersecurity and Information Assurance Economics Education English Foreign Language Geoscience Gerontology Government and Politics Health Studies Health Studies - Human Behavior Health Studies - Management History International Studies Journalism Studies Liberal Studies Management Mathematics Nursing Nursing Occupational Therapy Philosophy Physical Therapy Physics Pre-Engineering Psychology Psychology - Child Life Public Relations Public Relations - Journalism Studies Risk Management and Insurance Sociology and Anthropology Teacher Education Therapeutic Recreation
Sports Experience
Sport(s) Played
Coach's Name
Coach's Phone Number
Key highlights and statistics:
Do you excel in any additional sports?
Notable skills, honors, awards (athletic or academic):
Would you like to add comments, questions or points of interest?
Running Information
Please list your personal records for the following distances:
800m
1500m/1600m
3000m/3200m
Cross Country 5k
Road/Track 5k
Other Distances