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Thank you for your time in providing information for this form.  Please note this form does not serve as an application for the college.  This form is to provide East Mississippi Community College coaches with the necessary information about you and your sports background.  For an application to the college, please visit the EMCC homepage at http://www.eastms.edu.

Please remember to confirm your form once you hit the submit key, as hitting the submit key only saves your answers until you confirm your form.  If successful, you should receive a confirmation page of the form being submitted.  Thank you again for your interest in EMCC Athletics.


 
 RODEO 


PERSONAL INFORMATION      
       
Name Birth Date (mm/dd/yy)
Address Home Phone
City Cell Phone
State Email
Zip Code

       
GUARDIAN INFORMATION      
       
Mother or Legal Guardian Father or Legal Guardian
Occupation Occupation
Address Address
City City
State State
Zip Code Zip Code
Home Phone Home Phone
Cell Phone Cell Phone
Email Email
       
HIGH SCHOOL INFORMATION      
       
School Graduation Date
Address Grade Point Average (GPA)
City ACT Score
State Class Rank
Zip Code Honors
Phone Clubs
       
HIGH SCHOOL ATHLETIC INFORMATION      
       
Coach Other Sport(s) Played
Phone Awards (List all sports)
Email Achievements (List all sports)