Athlete Interest Form
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City/State
*
School Name
*
Grade
*
Please Select
6th
7th
8th
9th
10th
11th
12th
Post Grad
Sports Played
*
Primary Position(s)
Years of Experience
*
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Mother/Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Household Type
*
Please Select
Single-Parent
Co-Parenting
Blended Family
Guardian-Led
Briefly describe the support system in your home.
*
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Current GPA (if known)
Academic Strengths
Reading
Math
Science
Writing
Social Studies
None of the above
Not sure
Academic Areas Needing Support
Reading
Math
Study Skills
Test Prep
Attendance
Organization
Not sure
What goals do you have athletically, academically, or personally?
*
Do you currently have a mentor or coach you look up to?
*
Please Select
Yes
No
Not sure
What type of support do you feel you need most right now? (check all that apply)
Academic guidance
Mental/emotional support
Accountability
Exposure opportunities
Athletic development
Positive male role models
Leadership training
Why are you interested in joining Rewrite The Play?
*
Are you willing to participate in program expectations (meetings, mentorship sessions, workshops, academic support, etc.)?
*
Please Select
Yes
No
I want to learn more
Preferred Method of Contact
*
Please Select
Text
Phone call
Email
Parent/Guardian contact only
Signature
*
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