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Athletic Information FOOTBALL

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Athletic Information FOOTBALL
Athletic Information
FOOTBALL
Name
What ids your Local Address?
(Where you are living while attending NCTC)
Your Local phone number
Email Address
Height?
Weight?
Your Major Field of study?
List City and State of your hometown for game
programs
High School Head Coach
Hometown or local Newspaper
High School/Coach/ Bio Info:
Parents or guardian Information: ( for emergencies )
Mother’s Name
Father’s Name
Address
City
State
Zip Code
Parent’s contact numbers: ( H )(______) ________-_____________, (W) (______) ________-______________
East Grand Forks Campus | 2022 Central Avenue NE | East Grand Forks, Minnesota 56721 | 218.793.2800 | 1.800.451.3441
Thief River Falls Campus | 1101 Highway One East | Thief River Falls, Minnesota 56701| 218.683.8800 | 1.800.959.6282
www.northlandcollege.edu
Northland Community & Technical College is a Member of the Minnesota State Colleges and Universities System and is an Equal Opportunity Educator and
Employer.
FILL OUT BOTH SIDES OF FORM-PLEASE PRINT
PIONEER ATHLETICS
NJCAA ELIGIBILTY INFORMATION
Your Student ID #?
First
Middle
Last
Month, day and year of Birth?
M
D
Please
1st Season of playing Football at college level.
Check One
Month and Year of your High School Graduation?
Y
2nd Season of playing Football at college level.
M
Y
Name of your High School?
City and State of your High School?
Do you have a GED if you did not graduate?
YES___________
NO _____________
M
Y
What month and year did you first enroll at any college? M
Y
Month and Year of your GED?
Are you a Transfer Student? *See Insert
YES___________
NO _____________
How many previous full time semesters have you attended?
Month, year of your physical exam?
How many credits are you registered for this semester?
M
Do not fill in the following information!
Previous Full Time Term
Hours earned
GPA
Cumulative
Y
*TRANSFER ONLY
College(s) you attended:___________________
______________________________________
Dates you attended:______________________
Hour earned
______________________________________
GPA
Sports you participated in:_________________
Fly UP