Please fill out the following questionnaire
Click the SAVE button below when you're done.
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Please be sure to fill out all required fields:
First Name, Last Name, Select School, H.S. Grad Year (e.g. 2010)


Personal Information
Your Name:
First Middle Last
Preferred Name:
Street Address:
State / Zip:
Do you know anyone who attends/attended Western Michigan?:
If so, what are their names and relationship:
Previously enrolled/attended a Junior College/College/University? Please explain:
Date of Birth:
Month Day Year
Email Address:
Home Phone:
Cell Phone:
List the places you have lived:
Who is most important in helping decide what school to attend?: 1.
Brothers and Sisters (names and ages):
Top choices of schools:

Parent's Information
Mother's First Name:
Mother's Last Name:
Mother's Job:
Mother's Work #:
Mother's College:
Father's First Name:
Father's Last Name:
Father's Job:
Father's Work #:
Father's College:

Academic Information
Please use the SELECT SCHOOL Button to choose your school.
School Type:
School Name:
School Address:
School City:
School State / Zip:
School Phone #:
School Fax #:
Graduation Year:      GPA:     
Planned Major:
Academic Honors:
Guidance Counselor's First Name:
Guidance Counselor's Last Name:
SAT Test Date:   Score: 
ACT Test Date:   Score: 
Class Rank:
Junior College Name:
JC City:
JC State / Zip:
JC Phone #:
JC Coach First:
JC Coach Last:
JC Coach Office:
JC Coach Home:

Athletic Information
Coach's First Name:
Coach's Last Name:
Coach's Office #:
Coach's Home #:
Have you ever had surgery?:
If yes, explain what it was for and date:
School Honors:
Other Sports (if track list times):
Offensive Position:
Defensive Position:
40 Time:
Vertical Jump:
Jersey Dark:
Jersey Light:
Athletic Honors:
JC Athletic Honors:

When you have completed this questionnaire please click the save button.