Contact information
First name:   Last name:

Phone number:   E-mail:


Academic information

Academic average:   Grade:

Graduation date (MM/YY):   

Academic interest at Mount Allison:

Have you applied to Mount Allison?



Athletic information

Sport(s) of interest:


Height (feet/inches):   Weight (pounds):

School, team, or club:


Coach's phone number:

Coach's e-mail:


Please include any other relevant background or biographical information (including awards won, etc.) in the space provided.