Sonic Scholar Athlete

1.Student's Name:
*
2.Student's Phone:
*
3.Student's Email Address:
4.Student's Address:*
5.School Name:
*
6.School Phone:
*
7.School Address:*
8.School Contact:
*
9.Contact Relationship (teacher, coach...):
*
10.Grade Level:
*
11.Graduation Year:
*
12.Current GPA:
*
13.Sport(s) Played (as a member of an organized team):
14.Athletic Accomplishments and Goals:
15.Academic Activities, Achievements and Future Aspirations
16.Community Involvement and Volunteerism:
17.Would you be able to supply video of the student playing their sport?*
Yes No
18.Nominator's Name:
*
19.Nominator's Phone:
*
20.Nominator's E-Mail Address
21.Relation to Nominee:
*
22.Nominator's Address:*
23.Years Known:
*
24.Would you like to hear more about future FOX Charlotte contests, give-aways and offers?*
Yes No