Athletics and Recreation - University of Michigan-Dearborn

Future Student Athletes If you are interested in learning more about becoming an athlete at UM-Dearborn please fill out the form below. A coach from your selected sport will then contact you soon after we receive your information and answer any questions you may have. * required

General
Sport*
Name*
E-mail Address*
Address
City
State/Province
Zip/Postal Code
Home Phone

Age
Birthdate
Height
Weight
Father's Name
Mother's Name
Parents e-mail

Education
High School
Year of Graduation
GPA
ACT
SAT
Class Rank
Possible Major(s)
Previous College
Collegiate GPA
Have you applied to UM-D yet?	Yes	No
If yes, have you been accepted?	Yes	Have not heard
Are you considering any other schools?
Level of interest in UM-Dearborn	High
	Somewhat
	Unsure

Athletics	Primary Sport
Sport
Years of Participation
Position
Jersey Number
High School Coach
Club(s)
Years of Participation in Club(s)
Coaches Phone #
Accomplishments/ Honors/ Statistics

	Secondary Sport
Sport
Years of Participation
Position
Jersey Number
High School Coach
Club(s)
Years of Participation in Club(s)
Coach's Phone #
Accomplishments/ Honors/ Statistics

Additional Comment(s)

Physical Education, Recreation and Athletics
4901 Evergreen Rd.
Fieldhouse
Dearborn, MI 48128