Western Illinois Potential Football Student Athlete Questionnaire
Please fill out blanks and submit below.
Required Fields in Bold
Personal Information
Last Name
Nickname
First Name
Address
State
City
Zip
Cell Phone
E-mail
Twitter ID
Facebook Account
Date of Birth
Birthplace
Father's Cell Phone
Father's name
Father's Address
Mother's Cell Phone
Mother's Name
Parents Home Phone Number
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 State
School City
School Name
Coach's Cell Phone
Coach's Office Phone
Head Coach
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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COLLEGE SPORTS DIRECT
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