Online Recruiting Questionnaire

PERSONAL:

Name: 
            Last                                                                  First                                                          MI

Phone: E-Mail:

 Street Address:     
City:
State:    Zip:       

Social Security No.(optional):                           Birth Date:

Father's Name:                   College Attended:
Father's Occupation:           Company Name:

Mother's Name:                 College Attended:
Mother's Occupation:        Company Name:

Brother(s)/Sister(s):

Parents are (check applicable): 
Married  Separated Divorced, live with Father  Divorced, live with Mother  
Live with Grandparents  Live with Relatives  Other - explain

ACADEMIC:

School Name:         Head Coach's Name:
Guidance Counselor's Name:   

Date of Graduation: January February March April May June July August September October November December 2005 2006 2007 2008 2009 2010     
Test Scores:  S.A.T. -  Verbal:  Math:                    ACT -

Academic major you are interested in:

ATHLETIC:

Height:   Weight:                 Speed: (40 time)           Jersey Number:

Positions:   Offense:                     Defense:   
  Punter  Kicker  Long Snapper  Holder - PAT/FG  Punt/Kick-off Returner

Serious Injuries?   Yes No
     If yes, explain:

Other Sports Participated In: Basketball  Wrestling  Baseball  Track & Field
   Other - explain:

MISCELLANEOUS:

LHU Alumni/Students you know:

LHU Football
Head Coach: John Klacik
Bentley Hall G-55
Lock Haven University
Lock Haven, PA 17745
O: (570) 893-2250
F: (570) 893-2414