Phone: 323.823.4014 Email: ted@roadtocollegegolf.com WebSite: www.roadtocollegegolf.com Thank you for interest in Road To College Golf and for visiting our web site. Please take a moment to fill out the following questionnaire and click submit when complete. First Name: Last Name: Email: (required) Address: City, State, Zip: Gender: Male   Female Date of Birth: Graduation Class: Home Phone: Cell Phone: Father's Name: Father's Email: Father's Cell Phone: Mother's Name: Mother's Email: Mother's Cell Phone: High School: GPA: Year In School: TOEFL (Int. Students Only): SAT Score: ACT Score: Home Golf Courses: Swing Instructor: Putting/Shrt Gm Instructor: Trainer: Sports Psychologist: Other Coach: **Please include golf course or facility affiliation for each teacher. Top Five College Choices: 1. 2. 3. 4. 5. Golf Accomplishments in the past 24 months (date/tournament/scores/finish): 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? I am interested in learning more about the following Road To College Golf program(s):   Annual    Six-Month    Hourly    Daily    All Programs Have you registered for the NCAA Clearinghouse? Yes   No Are you an AJGA member? Yes   No How did you hear about Road To College Golf (includes person's name if applicable): General Comments: