First Name*
Last Name*
E-mail*
Address*
Cell Phone Number* – Area CodePhone Number
Birthdate* JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMonth31302928272625242322212019181716151413121110987654321Day20322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Year
Gender
Which Sport are you interested in playing?* SoftballBaseball
Position(s) Played:*
Number of Years Played* 1234+
Height
Weight
High School Coach’s Name
High School Coach’s Phone Number
Did you play on a Club/AAU Team?*
What was the name of your Club/AAU Team?
Club/AAU Coach’s Phone Number
Name of High School*
City & State of High School*
High School Graduation Date (Month & Year)*
High School GPA*
Name of College
College City & State
Hours Completed
Have you already applied for admission at Southeastern Community College?*
Is there additional information you’d like to provide?
Karlyn Stephens
Physical Education Instructor/Athletic Director/Softball Coach
(910) 788-6289
Nesmith Building, Rm 106-A
karlyn.stephens@sccnc.edu
Robert Burns
Broadcasting & Production Technology Instructor/Baseball Head Coach
(910) 788-6234
Nesmith, 106A
robert.burns@sccnc.edu