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(323) 823-4014

Email Ted

Mission Viejo, CA 92690

First Name:
Last Name:
City, State, Zip:
Male    Female
Date of Birth:
Graduation Class:
Home Phone:
Cell Phone:
Father's Name:
Father's Email:
Father's Cell Phone:
College Father Attended:
Mother's Name:
Mother's Email
Mother's Cell Phone:
College Mother Attended :
High School:
Graduation Year:
TOEFL (Int. Students Only):
SAT Math:
SAT Writing:
SAT Critical Reading:
Composite SAT Score:
Composite ACT Score:
When did you start 9th grade?:
What are the five most important criteria you will use during the college selection process?
Swing Instructor:
Putting/Shrt Gm Instructor:
Sports Psychologist:
Other Coach:
*Please include golf course or facility affiliation for each teacher.
Home Golf Courses:
Top Five College Choices:
Golf Accomplishments in the past 24 months
List upcoming tournaments that you are scheduled to participate in:
What year did you begin participating in serious competitive (regional and/or national multi-day) junior golf tournaments?
Do you currently have a college profile (academic/golf) posted on the Internet for coaches to review and if so, where? (AJGA, Junior Golf Scoreboard, etc.)
I am interested in learning more about the following program(s):
    Premium      Annual      Hourly     Daily     All
AJGA member?
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Registered for the NCAA Clearinghouse?
Yes    No
Would you like to receive a follow-up phone call from Road to College Golf?
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If yes, please indicate who to call along with their phone number.
How did you hear about Road To College Golf
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General Comments: