Prospective Student-Athlete

Men's Soccer Questionnaire

PERSONAL BACKGROUND

First Name: Last Name:
Name you go by: Email Address:
Phone Number: Number of Children in Family:
Street Address: City:
State: Zip:
Date of Birth (MM/DD/Year):  
Father's Name: Mother's Name:
Father's Occupation: Mother's Occupation:
Does either of your parents work at Washington University? Yes No
College Attended: College Attended:
Living with Mother Father Both Other          Ethnic Origin (optional):

ACADEMIC BACKGROUND (Please list Washington U. as one of the schools to receive your test scores.)

High School High School City:
High School State: High School Zip:
Coach's Name and Email Address: Home Phone:
Counselor's Name and Email Address: School Phone:
GPA: /4.0 Class Rank: / SAT-CR: SAT-M: SAT-W:
ACT Composite: Math: English: Reading: Science: Writing:
List the average grade you will receive (upon graduation) in these courses: Geometry: Trigonometry: Calculus: Physics:  Chemistry:
Honors or AP/IB Classes: Date of Graduation:
Senior Class Schedule:
Academic Honors:
Academic Interests:

1)

2) 3)
Other Colleges You are Interested In:

1)

2) 3)
Friends or Relatives who Attended Washington :


ATHLETIC BACKGROUND

Height:   Weight:   Shoe Size:    Position:   
Uniform No (light):     Uniform No (dark):    Preferred foot (list left, right or both):
Years on varsity:     Other Varsity Sports Played:
High School Record: Freshman:    Sophomore:   Junior:
Individual Statistics: Goals:    Assists:   Saves:   Goals Against:
Soccer Strengths:
Club or HS Honors (please identify club team):

Thank you for your time and interest. If you have any other questions, please contact:
Joe Clarke, Head Men's Soccer Coach
Washington University
Box 1067, One Brookings Drive
St. Louis, MO 63130
Phone: 314/935-5174
Fax: 314/935-5545
Email: joec@athletics.wustl.edu