Questionnaire

Personal Information

* Denotes required fields
First Name: *
Last Name: * MI:

Mailing Address: *
Street:
City: * St: * Zip: *
Telephone:
Email: Age:
Date of Birth: Height: Weight:

Scholastic Information

High School:
City:
Grad Date: *
Class Rank:
ACT/SAT Score:
HS GPA: College Transfer GPA:

Athletic Information

Goals Scored: Jr. Yr.: Sr. Yr.:
# Games Started:
Position: 2nd Position:
Goal Keepers Only GAA:
High School Team:
HS Coach:
Phone:
Club Coach:
Phone:
Strengths:
Honors: Record:

Jon Ireland
Head Men's Soccer Coach
York College
1125 East 8th Street
York, NE 68467
Fax: (402) 363-5738
Email: jireland@york.edu

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