Introduction Section
Please make sure to complete the club information portion. If your team/age group is not listed please include that information in the last question on the questionnaire.
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:
Mobile Number:
Twitter:
@
Instagram:
@
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
Parent 1's Email Address:
Parent 1's Cell Phone:
Parent 2's First Name:
Parent 2's Last Name:
Parent 2's Gender:
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Gender:
Guardian's Email Address:
Guardian's Cell Phone:
Academic Information
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School Name:
School City:
School State:
GPA:
SAT Test Date:
SAT Composite:
ACT Test Date:
ACT Composite:
TOEFL:
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Athletic Information
Jersey #




Positions
Soccer
Soccer
Other Questions
Club:
Team Name:
Please review the following website if you are located outside the United States: ( https://www.vpaa.uillinois.edu/resources/web_privacy/: ). :
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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