Iowa Lakes Community College

PROSPECTIVE PLAYERS QUESTIONNAIRE

Please complete the following form with all available information. Hit the SUBMIT button at the bottom to electronically submit. If submitting an application by mail, please type or print all answers and mail to address listed at the bottom.

PERSONAL DATA

Legal Name:  Last    First  Middle Initial
Marital Status: 
Email Address:
Date of Birth: 
Mailing Address:   Street 
City      State       Zip 
Phone:
Male  Female

SOCCER DATA

Height:  Weight:    Position(s) Played: 
College Position(s):    
Stats:  Goals    Assists  
Other Sports Participated in and number of years in each:  
     
Name of your current head coach:   Home Phone: 
Office Phone:    Coach's Email Address: 
Athletic honors received: 

SCHOLASTIC DATA

Name of your High School:    School Address: Street 
City      State       Zip 
Cumulative Grade Point:    Class Rank:    ACT Score: (if available) 
Graduation Date and Year:    School Phone: 
Have you filed the Family Financial Statement Packet: Yes  No  Date Filed: 
EFC#:    Counselor's Name:    
Academic Interest Area(s): 

FAMILY DATA
Mother's Name:  
Address: Street 
City      State        
Zip  Telephone #:
Father's Name: 
Address: Street 
City      State        
Zip    Telephone #:
Brothers & Sisters: (Names & Ages)

Marital Status of Your Parents
 Married
 Separated
 Divorced
 Deceased

Name/Signature:    Date:   

You may choose to submit this application electronically, or by mail, to:
Soccer Office
1900 N. Grand Ave., STE. B1
Spencer, IA 51301

 
    For more information contact Coach Farley at: kfarley@iowalakes.edu

 
Welcome to Iowa Lakes Community College

Copyright © 1996 - 2009 by Iowa Lakes Community College. All rights reserved.
Campuses in Algona, Emmetsburg, Estherville, Spencer and Spirit Lake.
If you would like us to mail you information, please complete this request form. 
Questions or comments? Please email us at info@iowalakes.edu or call (712) 362-2604 or 1-800-521-5054.
Equal Opportunity Statement