Wittenberg University — Field Hockey Questionnaire

Student Athlete Questionnaire: Field Hockey

Personal Information:

First Name:*
Middle Name:
Last Name:*
Preferred Name:
Birthdate:*	Month
Gender:	Male Female
Are you:*	a U.S Citizen/Permanent Resident an International
Citizenship:

Contact Information:

	Home Address:
Address Line1:*
Address Line2:
City:*
State:*
Zip:*
Country if outside U.S.
Home Phone:
Cell Phone:
Your E-mail:

Academic Information:

Areas of Academic Interest:

Top 3 College Choices:
1)	2)	3)

G. P. A.		Class Rank:		Class Size:
SAT (V):		SAT (M):		ACT(composite):

High School Information:

High School Name:

High School Phone:

Grad Year:

High School Coach:

High School Coach Phone:

Father’s Name:		Wittenberg alumnus?	Yes No
Mother’s Name:		Wittenberg alumnus?	Yes No

Wittenberg students/alumni that you know:

Financial Information:

Do you plan to apply for financial aid?

Financial aid applicants must complete the Free Application for Federal Student Aid (FAFSA). A Financial Assistance Estimator is also available through the Office of Admission.

Has the FAFSA been completed? Wittenberg's FAFSA code is: 003143

Please send: Viewbook Application Financial Aid Information

Mothers Occupation	Fathers Occupation

Field Hockey Experience/Player Profile

Total years playing field hockey:

Position:

Forward	Midfield	Defense	Goalie

Have you ever participated in the USFHA Futures Program? (Include years played)

Selected to:

NFT	Jr. Olympics	Futures Elite	FDIC

Club Team Information:

Team Name	Coach's Name	Phone #

Position Preference (use the positions identified above):

1st preference	2nd preference

Have you ever attended a summer field hockey camp? (If yes, when and where?)

Field hockey honors: Please list individual or team honors.

Personal assessment: Please list your strengths and areas needing improvement.

Wittenberg field hockey: Please list any questions about our field hockey program.

Favorite Hobbies:

Please provide the best method to contact you:

Campus Visitation

Have you visited the Wittenberg campus?

Yes	No	If so, When?

Do you plan to visit Wittenberg in the near future?

Yes	No	If so, When?

Would you like to meet with the field hockey coach during your campus visit?

Yes	No

Thank you for filling out this questionnaire and helping us to learn more about you!