Bloomsburg University Football Recruiting Form

* Required Fields

Note: Social security number will be required by the NCAA clearing house;
providing it now will save time when you apply to BU.


Name: *
Social Security: # *

Street Address:*
City:*
State:*
Zip Code:*

Telephone Number:*
Cell Phone Number:
E-Mail Address:*

High School:

Height:
Weight:
Speed-40:
Bench Press:
Squat:
Power Clean:
Age:
Birthdate (mm/dd/yy):

Position-Offense:
Position-Defense:
Special Team:
Jersey No: Home
Away:

SAT Score-Verbal:
SAT Score-Math:
SAT Score-Written:
ACT Score(s):

Grade Pt. Avg.:
Class Rank/Num.:
Graduation Date:

Curriculum Desired in College:

Athletic/Academic Awards:

Other High School Sports:

Any Serious Injuries?  YES NO

If Yes, explain:

Other Colleges You Are Considering:

Father's Name:
Occupation:
Bus. Phone:

Mother's Name:
Occupation:
Bus. Phone:

Guidance Counselor:
Principal:

Bloomsburg Alumni/Students You Know:

Leave Any Comments or Questions for the Bloomsburg Coaching Staff

If done, submit this form