Email Secondary Email

Women's Soccer

Email address *

Survey for interested student-athletes participating in Women's Soccer.

Personal Information

First Name *

Last name *

Parents Name

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone Number *

E-mail *

E-mail Verify *

Academic Information

High School Name *

High School Coach *

High School Coach Email/Contact Number

High School Graduation Year

ACT Score

Grade Point Average (GPA)

Intended Major

What Semester Will You Begin At Eureka?

Athletic Information

Years of eligibility remaining

Height (ft in)

Weight (lbs)

Dominant Foot

Sprint times (10 yard, 60 yards, 120 yards)

Distance times (1 mile, 2 mile)

Position(s)

Awards/Honors/Achievements

Link for highlight video

Other Sports Played

* = required field