Western Illinois Potential Football Student Athlete Questionnaire
Please fill out blanks and submit below.

Required Fields in Bold

 
Personal Information

First Name
 
Last Name
 
Nickname
 
City
 
Address
 
Zip
 
State
 
 
Cell Phone
 
E-mail
 
Twitter ID
 
Facebook Account
 
Birthplace
 
Date of Birth
 
Father's Cell Phone
 
Father's name
 
Father's Address
 
Parents Home Phone Number
 
Mother's Name
 
Mother's Cell Phone
 
Names of Brothers and/or Sisters
 
Family/Friends that have attended Western Illinois University
 
Who will assist you in choosing a college?
 
Religious Preference
 
Hobbies/Interests
 
 
Academic Information

School Name
 
School State
 
School City
 
Coach's Office Phone
 
Head Coach
 
Coach's Cell Phone
 
High School Graduation Year
 
SAT
 
ACT
 
GPA
 
Class Rank
 
Intended Major in College
 
Career Goal
 
 
Athletic Information

Height
 
Weight
 
Jersey #
 
Jersey Color
 
Offensive Position
 
Defensive Position
 
Specialty
 
Preferred College Position
 
Top 3 College Choices (Please put in order)
 
Any Athletic Injuries
 
Special Honor Awards
 
Link to Highlight Video
 
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