First Name Last Name First name you prefer to be called Date of Birth (MM/DD/YYYY) Home Address Street City Zip County Cell phone Email address Name of parent(s) or guardian(s) with whom you live Parent’s cell phone Parent’s email address Do you plan to work while at college? Full time? YesNo Part time? YesNo Work/study program? YesNo Name of your High School Principal Address Street City Zip Senior Counselor’s Name Senior Counselor’s Email GPA Class Rank Class Size ACT Score Academic Clubs Academic Awards High School Offices Held Community Activities Golf and Other Athletics Average Golf Score or Handicap? Where do you plan to attend college? Have you applied for admission? Have you been accepted? What field of study do you plan to pursue? I authorize the Birmingham Golf Association to use my name and photograph, and I agree not to hold Birmingham Golf Association liable for any such use Signature of Applicant Date (MM/DD/YYYY) Signature of Parent/Guardian Date (MM/DD/YYYY)
