Questionnaire - Football - Chadron State College

Name and Contact Information
First Name:
Middle Initial:
Last Name:
Mailing Address:
City:
State:
Zip:
Phone Number:
Email:
Best Day to Call:	M Tu W Th F Sa Su Any Day
Best Time to Call:	Morning Afternoon Evening Anytime
Personal Information
Date of Birth:
Age:
Height:
Weight:
Living with:	Mother Father Both Other
Father’s Name:
Father’s Occupation:
Mother’s Name:
Mother’s Occupation:
Parent’s Mailing Address:
City:
State:
Zip:
High School Information
High School Name:
Coach’s Name:
Coach’s Phone Number:
Position Played:
High School Honors:	All-conference, all-state, team captain, etc
Team’s Record Last Year:
Other Sports You Participated In:
Graduation Date:
Cumulative GPA:
ACT Score:
SAT Score:
Rank in Graduating Class:
Transfer Information
Name of Previous School:
Coach’s Name:
Coach’s Phone Number:
Position Played:
Brief Summary of Collegiate Career:
Graduation Date:	*Note: Transfers from 4-year institutions must obtain a release before CSC coaches can contact you.
Other Information
Prospective Major from CSC Application:
Have you applied for financial aid?:	Yes No
Have you registered with the NCAA Clearinghouse?:	Yes No
Specialty Areas:	Kick Punt Long Snap
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