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Introduction Section

Thank you for your interest in Southeast Missouri State University and our Women's Soccer program. By filling out this questionnaire completely, you will not only help our coaching staff contact you regarding participation in Women's Soccer, but also enable our admissions staff to begin the process of reviewing your academic information regarding your attendance at Southeast Missouri State University.

Choosing a college is a tremendous journey in a student-athlete's life. We at Southeast Missouri State University are honored that you have chosen to include us in your search.

We look forward to speaking with you further!

Adam Kleman
Assistant Coach
Southeast Missouri State Soccer

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:

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 Occupation:

Parent 1's College:

Parent 2's First Name:

Parent 2's Last Name:

Parent 2's Gender:

Parent 2's Occupation:

Parent 2's College:

Guardian Information

Guardian's First Name:

Guardian's Last Name:

Guardian's Occupation:

Academic Information

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School Name:

School City:

School State:

GPA:

SAT Composite:

ACT Composite:

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 Office:

Club Coach Home:

Club Coach Email:

Athletic Information

Height

Weight (in lbs.)

Jersey #

National Youth Team? (Yes/No)
NYT Date:
NYT Coach and Phone:
ODP Regional Team? (Yes/No)
ODP RT Date:
ODP RT Coach and Phone:
ODP Regional Pool? (Yes/No)
ODP RP Date:
ODP RP Coach and Phone:
ODP State Team? (Yes/No)
ODP ST Date:
ODP ST Coach and Phone:
Soccer Honors Received:
Other Important Soccer Experiences:

Positions

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Club Name:

Team Name:

Coach Last Name:

State:

City: