Questionnaire - Football - Chadron State College

Name & Contact Information
Last	First	M.I.
Mailing Address
City	State	Zip
Phone	Cell Phone	E-mail Address
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: Both Mother Father Other
Father's Name	Occupation
Mother's Name	Occupation
Parent's Address
City	State	Zip
High School Information
High School Name
Coach's Name	Coach's Phone Number
Positions Played	High School Honors (All-conference, all-state, team captain, etc.)
Team's Record Last Year	Other Sports You Particpated 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
Positions 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(s): from CSC Application
Major 1	Major 2
Have you registered for financial aid? Yes No	Have you registered with the NCAA Clearinghouse? Yes No
Specialty Areas: Kick Punt Long Snap