Athletic Interest Form | Middlesex School

First Name: *

Last Name: *

Gender: *

Street Address: *

City: *

State: *

Zip Code: *

Phone: *

E-mail: *

Date of Birth: *

Current Grade: *

Year of Proposed Entry: *

What grade would you apply for: *

Will you apply as a: *

DayStudent

BoardingStudent

Undecided

Name of current school: *

Academic average at current school:

Have you taken the (select all that apply):

SSAT

PSAT

SAT

notyet

Overall Test Percentile:

Your favorite sport is: *

Positions played in that sport:

Current Team Name:

Current Coach's phone#:

Current Coach's e-mail:

List achievement or relevant statistics in that sport:

Your second favorite sport is: *

Positions played in second sport:

Current Team Name Second Sport:

Current Coach's phone# second sport:

Current Coach's e-mail second sport:

List achievement or relevant statistics in second sport:

Your third favorite sport is: *

Positions played in third sport:

Current Team Name Third Sport:

Current Coach's phone# third sport:

Current Coach's e-mail third sport:

List achievement or relevant statistics in third sport:

Have you scheduled a visit to Middlesex:

Yes

No

If yes, what day:

Have you received Middlesex Admissions Material:

Yes

No

Additional Questions or Comments:

What other schools are you considering: