Miles College Football

FOOTBALL QUESTIONAIRE

GENERAL INFORMATION

Date: ______________

Name: _________________________ Nickname: _____________________ S.S.#: __________________ D.O.B.: ____________
Last First MI

Home Address _____________________________________________________________________________________________

Street City State Zip

Email: __________________________ Home #: _____________________­­­­­______ Cell#:___________________________

Father’s Name: _____________________________ Cell #: _______________________ Alma Mater: ________________________

Father’s Occupation: _________________________ Business #: ________________________ Email: _________________________

Mother’s Name: _____________________________ Cell #: _______________________ Alma Mater: ________________________

Mother’s Occupation: _________________________ Business #: ________________________ Email: _________________________

Relatives or friends who attended Miles College: ______________________________________________________________________

Hobbies: ______________________________________________________________________________________________________

Who is the most influential person in your life: ________________________________________________________________________

ACADEMIC INFORMATION

High School/ Junior College: _________________________________________ School Phone #: _____________________________

School Address: _______________________________________________________________________________________________
Street City State Zip

Counselor’s Name:______________________________________ GPA:______ SAT:___________________ ACT:____________________

Graduation Date:_________________________ Planned College Major: ________________________________________________________

Academic Honors:____________________________________________________________________________________________________

ATHLETIC INFORMATION

Coach’s Name:________________________________ Coach’s Office #:_____________________ Coach’s Cell #:_____________________

Position: Off___________ Def_____________ Preferred Position: ____________ Jersey #: ______Ht: ______ Wt: ______ 40 time: _______

Previous Serious Injury:________________________________________ Team Physician:_________________________________________

Physician’s Phone #:_____________________ Surgery Dates:________________________________________________________________

Sp. Area Positions (Check if any): Punter_______ Place Kicker_______ Kick Returner_______ Punt Returner_______ Deep Snapper_______

Athletic Honors:_____________________________________________________________________________________________________

Sports other than football and honors:____________________________________________________________________________________