NAME: _________________________________________________________________

ADDRESS: _____________________________________________________________

CITY: ______________________ STATE: ___________________ ZIP: __________

AGE: ____ DATE OF BIRTH: ____/ ____/ _____ PHONE: (_____)___________

EMAIL ADDRESS: ____________________________ MALE/ FEMALE: __________

AGE STARTED PLAYING GOLF ______ HANDICAP __________________OR

AVERAGE SCORE: _____________________________________________________

SCHOOL CURRENTLY ATTENDING: _____________________________________

DO YOU PLAY ON YOUR HIGH SCHOOL’S GOLF TEAM?_______________________

CURRENT GRADE: ___________________ GPA: _________________________

HIGH SCHOOL GRADUATION YR. ______ INTERESTED IN GOLF SCHOLARSHIP? ______

FATHER’S NAME: ________________ MOTHER’S NAME: ____________________

LIST STRUCTURED GOLF PROGRAMS IN WHICH YOU HAVE BEEN ACTIVE

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LIST GOLFING ACCOMPLISHMENTS:

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