Hockey Recruitment Form - UW Stout, Wisconsin's Polytechnic University

Name:
Street Address:
City:
State or Province:
Zip Code or Postal Code:
Cell Number:
	(include area code)
Phone Number:
	(include area code)
E-mail:
High School:
Graduation Date:
	(YYYY)
Birthdate:
	(MM/DD/YYYY)
Academic Interests:
Postion(s):
	(F,D,GK,W,C)
Height:
Weight:
Stats & Honors:
	(Juniors and/or High School...list yrs, teams, stats, honors)
HS Coach's Name:
HS Coach's Phone:
Other HS Sports & Interests:
Additional Info:
Juniors:
	(list teams, yrs, stats, honors)
Juniors Coach(es) Name(s):
Juniors Coach(es) Phone: