UW-Eau Claire Athletics - Men's Ice Hockey Prospect Form

* Indicates Required Field

Personal Information

Legal First name*:
Last name*:
Address*:
City, State, Zip*:
Birth Year:
Date of Birth*:
Phone:
Email*:
Father's Name:
Father's Occupation:
Mother's Name:
Mother's Occupation:

High School Information

High School:
High School Address:
City, State, Zip:
Coach's Name:
Coach's Phone:

Academic Information

Interested Area(s) of Study:
G.P.A:	out of Semesters
Class Rank:
Year of Graduation*:
ACT score:
SAT score:
Academic Honors/Awards:
Interest in Eau Claire:	Strong
	Average
	Slight
Other Schools Interested In:

Athletic Information

Position:
Height:
Weight:
Games Played:
Goals:
Assists:
If Goalie:	W: L: GAA:
Athletic Honors/Awards:
Junior Experience:
Other Sports Played: