Lindenwood University - Belleville

Belleville Athletics Recruitment Questionnaire

General Information

Date:   E-mail Address (required):

First Name:  MI: Last Name: 

Gender: MaleFemale             Date of Birth: 

Parents Names: 

Street Address: 

City:  State:  Zip Code: 

Country:        Home Telephone: 

Honors, Awards, Activities, Interests: 

Athletic Information

Height:   Weight: 

Vertical Jump:      Bench Press:      Squat: 

Athletic Positions Played (sport,position): 

Previous Coach Information
Coach:   Phone #:   Sport: 
Coach:   Phone #:   Sport: 
Coach:   Phone #:   Sport: 

Do you participate on any non-school related team(s)? Please list them: 

Academic Information

Have you filed an application for admission? Yes  No

Have you filed an application for financial aid? Yes  No

When would you like to begin attending Lindenwood?:

When did/will you finish high school/college?: 

High School/College Name: 

School Address: 

GPA:  SAT:  ACT:  Class Rank: 

Which type of information packet would you like to receive?

Which fields of study are you interested in? (use the ctrl button to select more than one)


Copyright 2014 Lindenwood University - Belleville • 2600 West Main Street • Belleville, IL 62226
Main Phone (636) 239-6000
Main Fax (636) 277-6001