Roller Hockey Recruit Questionnaire

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Please fill out the form below:

Email address *

General

First Name *

Last Name *

Home Address 1

Home Address 2

City

State

Zip

Contact Number

Cell Phone Number

Graduation Year

Background

Mother's Name *

Mother's Phone Number

Mother's Email

Father's Name *

Father's Phone Number

Father's Email

Parents Occupation

Submitted Video

Yes No

Date of Birth

x/x/xxxx

Have you visited Campus

Yes No

Academic

High School *

School Name

Address 1

Address 2

Address 3

City

State

Zip

Country

School Phone Number

Counselor's Name

Class Rank

GPA *

SAT Math

SAT Verbal

SAT Writing

SAT or ACT Total *

Academic Honors

Intended Major

Other College Choices

Athletic

Height

Feet" Inch'

Weight

HS Coach's Name

HS Coach's Phone

HS Coach's Email

Team Honors

Individual Honors

Male or Female

* required field