PURDUE FOOTBALL QUESTIONNAIRE
* denotes required field
 
 
Personal Information
Graduation Year *
First Name * Middle Name
Last Name * Preferred Name
Address * City *
State * Zip *
Social Security No Email *
Home Phone Cell Phone *
Facebook Twitter
Birth Date
 
 
Family Information
Father's Name Father's Occupation
Father's Employer Father's Home phone #
Father's Work phone # Father's Cell phone #
Father's Email Father's College
 
Mother's Name Mother's Occupation
Mother's Employer Mother's Home phone #
Mother's Work phone # Mother's Cell phone #
Mother's Email Mother's College
 
I live with
The names and ages of my siblings are:
The best way to reach me is (choose one)
 
 
Scholastic Information
School State *
Choose your School
If you selected a school, skip school info. If you couldn't find your school, check the checkbox below and enter its data
I couldn't find my School
School Type
School Name School Address
School City School ZIP
School Phone School Fax #
Counselor's First name Counselor's Last name
Coach's First Name Coach's Last Name
Coach's Work Phone Coach's Home Phone
Coach's Cell Phone
 
 
Transcript Release
I authorize the release of my transcript and test scores to PURDUE.