ECC Athletics

If you are a student athlete and are interested in becoming an Ellsworth Panther, please complete this form as completely as possible. We will then get back to you with more information.

Demographic Information:

Name (first, last)
Street Address
City State Zip Code
E-mail address
Phone #
Cell Phone #

Demographic Information:

Date of Birth
Gender: Male Female
High School
Address
City State Zip Code
Graduation Year GPA Class Rank
Academic Interests:

Athletic Information:
Position Played in High School
Height Weight
High School Coach
Coaches Phone #
Other Sports
Questions or Comments:

1100 College Ave., Iowa Falls, IA 50126 • Ph: 1-800-322-9235 • E: eccinfo@iavalley.edu