Thank you for your interest in the University of Wisconsin-Platteville Men's Soccer Program.

Personal Information

First Name

Middle Initial

Last Name

Street Address
City, State, Zip Code

Home Phone

E-mail Address

Father's Name

Father's Occupation

Mother's Name

Mother's Occupation

Names and Ages of Brothers and/or Sisters

Academic/Athletic Information

Are you a transfer student?
Yes No

If yes, what school?

Semester You Plan on Transferring

High School

Head Coach

Club Team Name

Club Coach's Name

Number of Years Played Club

Intended Major

Class Rank

SAT Score

ACT Score

Grade-Point Average

Date of Graduation

Academic Honors

Friends or Family Attending or Who Have Attended UW-Platteville




Other Sports in Which You Participate

Athletic Honors


Thank you for your time and interest in University of Wisconsin-Platteville men's soccer.