Men's Soccer -- Wright State University

Prospective Athletes

Personal Information

First Name:

Middle Name:

Last Name:

Address:

City:

State/Province:
US or Canada only

Zip:

Country:
if outside US/Canada

Phone:

Phone Country Code:
if outside US/Canada

Height:

Weight:

E-mail Address:

Birthday:

Father's Name:

Occupation:

Telephone:

Alma Mater:

Mother's Name:

Occupation:

Telephone:

Alma Mater:

Parent or Guardian's Address:

Scholastic Information

High School:

Address:

City:

State:

Zip:

Phone:

Graduation Year:

Guidance Counselor:

Guidance Counselor Phone:

Principal:

Principal Phone:

Desired Major:

Class Rank:

GPA: out of

NCAA core GPA: out of

SAT Verbal:

SAT Math:

ACT:

Are you registered with the NCAA Clearinghouse Initial Eligibility? Yes
No

Soccer/Athletic Information

Coach:

Coach Phone:

Club:

Club Coach:

Club Coach Home Phone:

Preferred Position:

Other Position:

Please fill all that apply. Select past playing experience and list date, coach and coach's telephone number.

Natl Youth Team

Date:
Coach:
Phone:

Regional Team

Date:
Coach:
Phone:

Regional Pool

Date:
Coach:
Phone:

State Team

Date:
Coach:
Phone:

List name, address and phone number of two coaches/scouts who can discuss your soccer ability and background.

Contact 1:

Contact 2:

Additional
Comments: