Purdue Football
Future Boilermaker Questionnaire
Personal Information
Graduation Year *
First Name * Middle Name
Last Name * Preferred Name
Address * City *
State * Zip *
Email * Cell Phone *
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Instagram Birth Date
 
Father's Name Mother's Name
Guardian's Name Marital Status
I live with The best way to reach me
Academic Interests
School Information
School State * Choose your School
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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
Athletic Information
Projected Position * Jersey Number
Height * ft in Weight *
Other Sports
Transcript Release
I authorize the release of my transcript and test scores to PURDUE.