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Personal Information:

First Name:
Last Name:
Street Address:
City:
Province/State:
Postal/Zip Code:
Country:
Email Address:
Date of Birth:
Home Phone:
Cell Phone:

High School Information:

High School Name:
Street Address:
City:
Province/State:
Postal/Zip Code:
Country:
Phone:

Athletic Background:

Name of Last or Current Team:
Name of Last or Current Coach:
Coach's Phone Number:
Position(s) Played:
Height:
Weight (NA if Not Applicable):
Number of Years Played:

Sport Specific Information:

Shoots (L or R):
Number of Goals Last Year:
Number of Assists Last Year:
Goals Against Average Last Year:
Save Percentage Last Year:
Name of Club Team:

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 Wilfrid Laurier University? (Yes/No/Unsure):
To what other universities have you applied, or will you apply to?:
Security Code:
Please enter the following text in the Security Code Box Below.


Video:

Highlight videos are the best way for our coaches to see you in action. Please provide the coach with a link to highlight video or a DVD at your earliest convenience. This is a requirement for Football.
If sending a link, please provide it below under 'Other Information'.

Other Information:

Use this section to tell us anything else about yourself that you feel we should know.

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