Please fill out this questionnaire completely before submitting. Transfers - note you must have a release signed by the Director of Athletics at your current institution before a Northeastern State University representative can speak with you.

Personal Information

NAME

ADDRESS

CITY       STATE        ZIP

HOME PHONE        CELL PHONE

EMAIL ADDRESS         BIRTHDATE    

HEIGHT                        WEIGHT

Parents/Guardians

MOTHER'S NAME 

FATHER'S NAME 

Academic Information

HIGH SCHOOL        GRADUATION YEAR

HIGH SCHOOL ADDRESS

CITY       STATE        ZIP

GPA           CLASS RANK 

SAT           ACT 

AREAS OF ACADEMIC INTEREST 

Athletics Information

CLUB TEAM          CLUB COACH/PHONE NO. 

POSITION            UNIFORM # 

HIGH SCHOOL COACH/PHONE NO.      

POSITION             UNIFORM # 

DO YOU HAVE ODP EXPERIENCE:   Yes    No         

IF YES, PLEASE INDICATE HIGHEST LEVEL YOU ACHIEVED
District        State        Regional        National

SOCCER AWARDS (Club & HS) 

Upcoming Tournaments (Name/Date/Location)
 

HAVE YOU APPLIED TO NSU?  Yes     No 

HAVE YOU REGISTERD WITH THE NCAA CLEARINGHOUSE? Yes     No 

NCAA CLEARINGHOUSE #