Northern State Soccer Questionnaire

Personal Information
Full Name
Social Security #
Street Address
City
State
Zip
Home Phone
Cell Phone
Height
Weight
High School Information
High School
Date of HS Graduation
Class Rank (example: 23 of 129)
GPA
ACT/SAT score
High School Coach
HS Coach Phone
Other HS Sports Played
HS Academic Honors
HS Athletic Honors
Club Information
Club Team
Club Coach
Club Coach Phone Number
Position
Other Information
Have you applied to the NCAA Clearinghouse? yes no
Anticipated academic major 

Your E-mail address*: 
 
*This is a REQUIRED FIELD. If you do not have an e-mail address, 
type in your last name with NO SPACES!

Extra Information:

Hitting "Send" will e-mail the form directly to NSU head soccer coach Steve Kehm.
Hitting "Clear" will clear the form and not send it anywhere.
Thanks for your interest in Northern State Soccer!

 
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