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Introduction Section
Thanks for your interest in the Kentucky Men's Soccer Program. Please fill out the following questionnaire as completely and accurately as possible.
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Grad Year:
---Grad Year---
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
Email Address:
Home Phone:
Mobile Number:
Skype:
Google Talk:
FaceBook:
paste the URL from your Facebook profile
Twitter:
@
enter your twitter username only
What is your connection to this university:
Parent(s) Information
Mother's First Name:
Mother's Last Name:
Mother's Occupation:
Mother's Email Address:
Mother's Cell Phone:
Mother's Business Ph.:
Mother's College:
Living With:
Yes
No
Siblings (Names & Age):
Father's First Name:
Father's Last Name:
Father's Occupation:
Father's Email Address:
Father's Cell Phone:
Father's College:
Living With:
Yes
No
Most Influential People in Your Life: (1)
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Gender:
Male
Female
Guardian's Email Address:
Guardian's Cell Phone:
Living With:
Yes
No
Academic Information
School Name:
School Address:
School City:
School State:
---Select State---
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mariana Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Out. Is.
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
xNo Statex
School Zip:
School Phone#:
School Fax#:
Counselor's First Name:
Counselor's Last Name:
Counselor's Phone:
Counselor's Fax:
Counselor's Email:
GPA:
SAT Test Date:
SAT Reading:
SAT Math:
SAT Writing:
SAT Composite:
ACT Test Date:
ACT Sum Score:
ACT Composite:
ACT English:
ACT Math:
ACT Reading:
ACT Science:
TOEFL:
Class Rank:
Out Of
Intended Major:
Have you Joined the Eligibility Center?
Yes
No
Eligibility ID:
Club Information
Club Name:
Club Address:
Club City:
Club State:
---Select State---
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mariana Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Out. Is.
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
xNo Statex
Club Zip:
Club Coach:
Club Coach Cell:
Club Coach Office:
Club Coach Home:
Club Coach Email:
Athletic Information
Height
Select
8' 11"
8' 10"
8' 9"
8' 8"
8' 7"
8' 6"
8' 5"
8' 4"
8' 3"
8' 2"
8' 1"
8' 0"
7' 11"
7' 10"
7' 9"
7' 8"
7' 7"
7' 6"
7' 5"
7' 4"
7' 3"
7' 2"
7' 1"
7' 0"
6' 11"
6' 10"
6' 9"
6' 8"
6' 7"
6' 6"
6' 5"
6' 4"
6' 3"
6' 2"
6' 1"
6' 0"
5' 11"
5' 10"
5' 9"
5' 8"
5' 7"
5' 6"
5' 5"
5' 4"
5' 3"
5' 2"
5' 1"
5' 0"
4' 11"
4' 10"
4' 9"
4' 8"
4' 7"
4' 6"
4' 5"
4' 4"
4' 3"
4' 2"
4' 1"
4' 0"
Weight (in lbs.)
Jersey #
National Youth Team? (Yes/No)
NYT Date:
NYT Coach and Phone:
Are films of your games available? (Yes/No)
If yes, how are they obtained?
Other Important Soccer Experiences:
Positions
Soccer
Goalkeeper
Center-back
Full-back Left
Full-back Right
Center midfield
Defensive midfielder
Attacking midfielder
Left Side midfielders
Right Side midfielders
Center forward
Striker
Other Questions
When you have completed this questionnaire please click submit questionnaire.
School Name:
State:
---State---
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
xNo Statex
City:
Club Name:
Team Name:
Coach Last Name:
State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mariana Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Out. Is.
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
xNo Statex
City:
Club Name:
Team Name:
Club State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mariana Islands
Maryland
Massachusetts
Michigan
Minnesota
Minor Out. Is.
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
xNo Statex
Club Coach First Name:
Club Coach Last Name:
Club Coach Email:
Club Coach Mobile: