Recruiting Questionnaire

Personal Information

Graduation Year:

Date of Birth:

First Name: *

Last Name: *

Contact Information

Street Address: *

City: *

State: *

Zip Code: *

Home Phone Number: *

Include area code

Cell Phone Number:

Email Address: *

Contact Name:

If other than student, please enter first and last name

Father's Name:

Father's Occupation:

Mother's Name:

Mother's Occupation:

Academics

High School: *

Cumulative GPA:

ACT / SAT Score:

Possible Academic Major:

Athletics

Position:

High School Jersey Number:

Club Team:

Club Team Jersey Number:

Other Sports Played:

Honors/ Questions/ Comments:

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Brian Haley, Head Men's Soccer Coach
Athletic Department
310 E. Market Street
Tiffin, OH 44883-2382
Telephone: 419-448-2119
Email: bhaley@heidelberg.edu

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