Dixie State College of Utah Athletics

Football Recruiting Form

PLEASE NOTE: This form is not an application for admission to Dixie State College of Utah. This form will be used by the coaching staff to help determine prospective student-athletes. Please visit the Office of Admissions site for more specific information on admission to Dixie State College of Utah.

Personal Information
Name (First, Mi, Last)
Address
City, State Zip
Home Phone
Date of Birth	(MM/DD/YR)
Email Address
Gender	Male Female
Freshman/Transfer	First Year (Freshman) Transfer
Citizenship	U.S. Citizen Permanent Resident International Student
Ethnic Background (optional)	African American Caucasian/White Native American Multiracial (please specify) Other (please specify)		Asian American Hispanic Pacific Islander
Academic Information
School Name	High School		Community or Other College

City, State Zip
Graduation Month/Year	/		/
Grade Point Average
SAT Scores	Verbal Math
ACT Composite Score

Family Information
Father's Name	Occupation
Attended college?	Yes No		College attended:
Mother's Name	Occupation
Attended college?	Yes No		College attended:
Parents are:	Married	Divorced	Separated
I live with:	Both	Father Mother	Other:
Number of brothers & sisters	Number currently attending college: College(s) Attended/Attending
Religious Affiliation (optional)
Annual Household Income (optional)	0-$45K $46K-$75K $76K-$125K $126K and over
Do you plan to apply for Financial Aid?	Yes No
General Information
Have you already completed an application?	Yes No
Other Sports you compete in			(To enter multiple choices, select your first option and subsequently hold down the "Control" key (or "Command" key on Macs) while selecting your additional options.)
Personal bests/ honors in other sports
Hobbies
Rank your top 3 college choices:	1)
	2)
	3)

Athletic Information

Football Positions

Offense:

QB	RB	FL	WR	TE	OC

Defense:

DE	DT	LB	DB

Specialty:

Punter	Kicker	Returner

Preferred Position:

Jersey #

Height

i.e. 5'11

Weight

Vertical

40 Yard Dash Time

Football Honors

Head Football Coach

Additional Information

INDIVIDUAL ATHLETIC HONORS

TEAM ATHLETIC HONORS

CAMPS ATTENDED

ADDITIONAL COMMENTS

Dixie State College Athletics

225 South 700 East, St George, UT
1-877-5GO-REBS