Soccer Recruitment Survey

Soccer Recruitment Survey

Kankakee Community College
General Information
Full Name*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Email*

Confirmation Email
Parents' names*
Parents' occupations
Parent(s) Home Phone

Area CodePhone Number
Parent(s) Cell Phone*

Area CodePhone Number

Academic Information
Programs of Interest*
Other schools considering*
ACT score
SAT score
ACT/SAT composite score
High School*
Year of High school graduation*
High school city*
High school state / country*
High school coach*
High school coach phone*

Area CodePhone Number
High school coach email
Summer team
Summer coach
Summer coach phone

Area CodePhone Number

Soccer Information
Positions*
Height*
Weight*
Athletic Awards*
Other Sports*
Additional information or questions
To print your form, choose print BEFORE submitting.
Should be Empty: