Introduction Section
Please take a few moments to completely fill out this questionnaire and be sure to click the submit button at the bottom of the page.
Questionnaire Code
(not required):
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
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 Address (If Different):
Mother's City:
Mother's State:
Mother's Zip:
Mother's Occupation:
Mother's Email Address:
Mother's Cell Phone:
Mother's Business Ph.:
Mother's College:
Living With:
Siblings (Names & Age):
Father's First Name:
Father's Last Name:
Father's Address (If Different):
Father's City:
Father's State:
Father's Zip:
Father's Occupation:
Father's Email Address:
Father's Cell Phone:
Father's Business Ph.:
Father's College:
Living With:
Most Influential People in Your Life: (1)
Most Influential People in Your Life: (2)
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Guardian's Address (If Different):
Guardian's City:
Guardian's State:
Guardian's Zip:
Gender:
Guardian's Occupation:
Guardian's Email Address:
Guardian's Cell Phone:
Guardian's Business Ph.:
Guardian's College:
Living With:
Academic Information
School Name:
School Address:
School City:
School State:
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 Reading:
SAT Math:
SAT Composite:
ACT Sum Score:
ACT Composite:
Class Rank:
Out Of
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Athletic Information
Height
Weight (in lbs.)
Jersey #
Positions
Offense
Defense
Special Teams
Other Questions
List any other sports you play::
List any injuries you may have::
List five colleges you would attend if given a choice::
List two most influential people in your life::
I give the University of Nevada permission to acquire & evaluate my transcripts & test scores: (Please type your name):
When you have completed this questionnaire please click submit questionnaire.
School Name:
State:
City:


Club Name:
Team Name:
Coach Last Name:
State:
City:


Club Name:
Team Name:
Club State:
Club Coach First Name:
Club Coach Last Name:
Club Coach Email:
Club Coach Mobile: