Introduction Section
Thank you for your interest in Purdue University Northwest and our E-sports Program. Please fill out this form in its complete entirety. For additional contact or questions please contact Head Coach Justin Bragg at bragg10@pnw.edu.
Personal Information
First Name:
Last Name:
Preferred Name:
Country:
Address Type:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
What is your connection to this university:
Academic Information
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School Name:
School City:
School State:
GPA:
SAT Composite:
ACT Sum Score:
Intended Major:
Other Questions
Do you play League of Legends?:
If so, what is your Summoner Name?:
Preferred Role (AD Carry, Jungle, Mid, Support, Top)?:
Secondary Role (AD Carry, Jungle, Mid, Support, Top)?:
Top 3 Champion Pool:
Current League (Unranked, Bronze, Silver, Gold, Platinum, Diamond, Master, Challenger)?:
Discord ID?:
While not required, please share a link to game play of yourself in your primary role (YouTube, Twitch, etc.). This will help our staff in our scouting process. Leaving this blank will not diminish our consideration of you for the Esports program.:
What other games do you play?:
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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