Today's date*

Student's first name*

Student's last name*

Gender*
male female

Birth date*

Age*

I am applying for*
full time boarding post grad boarding full time non-boarding post grad non-boarding

Home address street*

Home address city*

Home address city/provence*

Country*

Student's email address*

Do you have a chronic medical condition such as diabetes, seizure disorder, severe allergies,
or mental health disorder?*
yes no

Leave this empty:

If yes, please explain:

Native Language / Languages you speak fluently*

Referred by:
(Specify person, magazine, web site, ad, Premier Golf Academy representative, other)

Education
(school currently attending)

Name of current school*

School city*

School state/provence*

Zip code*

School country*

School phone*

Current grade level*

Current grade point average*

Expected graduation year*

Have you been suspended, expelled, or dismissed from any school for any reason?*
yes no

If yes Please Explain:

Family Information

With whom does the applicant live*

Who should receive sport correspondence?

Parent/Guardian #1

Name

Home address

City

State/provence

Country

Email

Phone

Parent/Guardian # 2

Name

Home street address

City

State/provence

Country

Email address

Phone number

Applicant Questionnaire

I. Objectives: List two short-term goals and two long-term goals in the space below.

Short term goals:

Long Term Goals:

What do you hope to gain from your experience at Premier Golf Academy:

How did you first start to play golf:

Describe your typical daily schedule:

Briefly describe yourself as a person:

Handicap

Junior Golf Scoreboard Ranking

World Amateur Ranking

Most Recent Tournament Results

Tournament #1:

Association

Golf Course

Scores

Tournament #2:

Association

Golf course:

Scores

I affirm that I have answered all questions truthfully.
Student initials: