GPSA Athletic Admission Form

Georgia Prep Sports Academy Inc.

Application for Admission

Admission: 678-663-7514 Fax: 770-389-3765

Student Information
Student's Name	*	* *
Age	*	Height* Weight*
Street Address	*
City	*	StateZip
Social Security #	*	Date of Birth*
Are you a:	*	U.S. Citizen Naturalized Citizen
Place of Birth	*	Country of Citizenship*

How did you hear about Georgia Prep Sports Academy?
Please mark the sport in which you are interested	*	Football Basketball Baseball
Academic Information
Present Grade	*
Present School Attending	*	From* To*
Address	*
City	*	StateZip
Guidance Counselor	*	School Phone*
Other schools attended in the past three years
School Name		From To
Address
City		StateZip
Guidance Counselor		School Phone
List any awards or honors you received

Parent/Guardian Information
Father/Guardian’s Name	*
Home Address (If different)
Social Security #	*	Occupation*
Employer/Job Title	*	Address
Phone	*	Work* Cell
E-mail	*	Fax

Mother/Guardian’s Name	*
Home Address (If different)
Social Security #	*	Occupation*
Employer/Job Title	*	Address
Phone	*	Work* Cell
E-mail	*	Fax