Personal Information:
Name (First and Last): Date of Birth (DD/MM/YY):
Street Address: City:
Province/State: Postal/Zip Code:
Country:    
Telephone: Fax:
2nd Phone: E-mail Address:
High School Information:
 
High School Information
Club Team Information
Name of High School: Club:
Province/State: Province/State:
HS Coach's Name Club Coach's Name
HS Coach's Phone Club Coach's Phone
HS Coach's Email Club Coach's Email
     
 
Academic Information:
Area of Academic Interest – What do you wish to study?
Current Academic Year (Grade):
Last Reported Cumulative GPA:
Intended Year of Graduation:
Have you applied, or will you apply to Nipissing University? (Y/N/Unsure):
To what other universities have you applied, or will you apply to?
Position(s) Played:
 
Please check the box of the position(s) played:
Striker Central Defense Goaltender National Level
Left Wing Midfielder Sweeper
Describe Your Play
 Provincial/State Level
Right Wing Midfielder Right Wing Defender Defensive High Schol Level
Centre Midfielder Left Wing Defender Attacking Free Kick Specialist
Height: ft.
Weight: lbs.
Time of 40 Yard Dash :
Maximum Bench Press:
Maximum Squat:
Your Summer Team or Club




If you haven't received confirmation within two days that we have received your information please e-mail: Marc LaRochelle at marcl@nipissingu.ca directly. Thank You



 
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