Life Rugby Recruitment Form

Personal Information

Name (First, Last):

Street Address:                   Apt. #:

City:          State:         Zip:

Country:

High School:

Previous High School (if currently doing a Post Grad year):

Current College (if already attending and interesting in transferring):             Year in College:

Home Phone #:           Cell Phone #:

Email:

Date of Birth (mm/dd/yy):

Personal website (if you have one):

Interests, hobbies:

Extracurriculars:

Father's Name:

Father's Occupation:

Father's Work or Cell Phone #:

Mother's Name:

Mother's Occupation:

Mother's Work or Cell Phone #:

Lives With:

Rugby Information

Position:

Are You Sending Film?

Height (feet - inches):      Weight (pounds):

High School Coach:

High School Coach's Phone:

High School Coach's Phone #2:

High School Coach's Email:

High School Coach's Address:

Rugby Achievements (captain, team awards, all-league (specify league), all-state, provincial, national, etc.):

Other sports played (& positions):

Honors, achievements in other sports:

Statistics (from your last full season of rugby)

Tries:      Total Points Scored:      Penalty or Drop Goal Kicks (if applicable):

Number of Years you have played rugby:

Rugby camps and tournaments you have attended or are planning to attend (include dates and location):

Academic Information

SAT Math:      SAT Reading:      SAT Writing:      Taking SAT Again?:

ACT:      Taking ACT Again?:

GPA:      Class Rank:      HS Graduation Date (mm/dd/yy):

Guidance Counselor:

Guidance Counselor Email:

Academic Interests:

Academic Honors:

Other Universities you are interested in:

Colleges that are actively recruiting you:

Application & Visit Information

Interest level in Life University:

Have you applied to Life University?      If so, date application submitted (mm/dd/yy):

Have you been accepted to Life University?:      Date accepted (mm/dd/yy):

Have you visited Life University?:

If not yet or you plan to visit again, when (mm/dd/yy)?

Message for Coach Lawrence (more information about yourself, questions about the rugby program or university, etc.):