Student Athlete Registration Form

SECTION ONE: General Information

Full Name: *

Email address *

Student Email: *

@student.fitchburgstate.edu

FSU Student ID Number *

@

Cell Phone #: *

Date of Birth: *

High School Name: *

Year of Graduation: *

Have you enrolled as a student at any other college, including a junior college? *

Yes No

If you answered YES to the previous question, list name(s) of previous institutions?

Class Year: *

Fr So Jr Sr

Sport(s): *

Ethnicity *

American Indian Asian Black Native Hawaiian White 2 or more Other/unknown

Housing: *

On-Campus Off-Campus Commuter

SECTION TWO: Hometown Information

Home Adress: *

City: *

State: *

Zip Code: *

Parents' Names: *

Parent's email address: *

SECTION THREE: Sports Information

Position(s): *

Height: *

Weight (male teams only) :

Junior Team/League (ice hockey only):

Other High School Sports Played:

Athletic, academic, team and other honors achieved:

Major (if undecided, please use TBD): *

Minor (if applicable):

Academic Achievements at Fitchburg State:

SOCIAL MEDIA INFORMATION: Fitchburg State Athletics would like to include you in our social media posts. If you're interested in being tagged on posts about you, please fill out the following information:

Twitter Handle:

Instagram Handle:

Consent: *

By clicking this box, you give the Sports Information Office permission to release pertinent data about you to local and hometown media outlets

Signature (Type your name): *

Date: *

* required field