Loudoun United Sports Academy | Building Champions in the Classroom and on the Field

Name

First

Last

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone

Place of Birth (State and/or Country)

Gender

Primary Language

Parent / Guardian #1 Name (First, Last)

First

Last

Parent / Guardian #1 Email Address

Parent / Guardian #1 Phone Number

Parent / Guardian #2 Name (First, Last)

First

Last

Parent / Guardian #2 Email Address

Parent / Guardian #2 Phone Number

Current School Attending (23/24 Academic Year)

Please upload a copy of your 2022-23 year-end report card

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Please share any academic highlights (i.e. awards or achievements) you'd like us to know about you

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Please share any other extra-curricular activities you participate in outside of school

Current Club

Current Club Team Name

Current Position(s)

Do you currently play on your High School team?

Current High School Team

LUSA: Interest & Application Form