Introduction Section
Welcome to the Purdue University Northwest Men's Soccer Questionnaire. Thank you for providing your information and your interest in our program.
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Country:
Address Type:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
Skype:
FaceBook:
Twitter:
@
Instagram:
@
What is your connection to this university:
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
Parent 1's Address (If Different):
Parent 1's City:
Parent 1's State:
Parent 1's Zip:
Parent 1's Occupation:
Parent 1's Email Address:
Parent 1's Cell Phone:
Parent 1's Business Ph.:
Parent 1's College:
Living With:
Siblings (Names & Age):
Parent 2's First Name:
Parent 2's Last Name:
Parent 2's Gender:
Parent 2's Address (If Different):
Parent 2's City:
Parent 2's State:
Parent 2's Zip:
Parent 2's Occupation:
Parent 2's Email Address:
Parent 2's Cell Phone:
Parent 2's Business Ph.:
Parent 2's College:
Living With:
Most Influential People in Your Life: (1)
Most Influential People in Your Life: (2)
Academic Information
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School Name:
School Address:
School City:
School State:
School Zip:
GPA:
SAT Test Date:
SAT Reading:
SAT Math:
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?
Eligibility ID:
Club Information
Club Name:
Club Address:
Club City:
Club State:
Club Zip:
Club Coach:
Club Coach Cell:
Club Coach Email:
Athletic Information
Height
Weight (in lbs.)
Jersey #


HUDL
YouTube


Events
Positions
Soccer
Soccer
Other Questions
When you have completed this questionnaire please click submit questionnaire.
School Name:
OR :
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:

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