KCKCC Men's Soccer Questionnaire

Email Secondary Email

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Email address *

Personal Information

First Name *

Last Name *

Address *

Address

City *

State *

Zip Code *

Home Phone Number *

Cell Phone Number *

Age *

Birthdate *

Email Address *

Father's Name *

Mother's Name *

School Information

Name of School Presently Attending *

Address *

Address

City *

State *

Zip Code *

ACT Score

SAT Score

GPA *

Year of Graduation *

Counselor's Name *

Counselor's Phone number *

Rank

Date of ACT

Date of SAT

Present Class *

Freshman Sophomore Junior Senior

Soccer Information

Position *

School Coach *

Phone Number *

Club Team

Club Coach

Club Phone Number

Awards in Club Play

Other

Previous College Background

College Transfer From

Address

City

State

Zip

Date of Initial Enrollement

Jersey Number

Coach's Name

Coach's Phone Number

Position Played

Hours Completed

Hours in Progress

Other Information

Recruit Me

Yes No

Other Sports Participated in and Positions

Honors and Awards

Injuries and Current Status

Please list in order of importance the factors influencing the choice of school to attend

Additional Information or Comments

* required field