ESports Athletic Questionnaire

Student Information

First Name

Preferred Name

Last Name

Birthdate

Email Address

For best email deliverability, we recommend not using a school email address.

Mobile Phone Number

May Cottey College contact you over SMS?

Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Parent/Guardian Relationship Type

Do you want to provide information for a second parent/guardian?

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Parent/Guardian Relationship Type

Academic Information

Anticipated Start Term

Student Type

Current School Name

Current School CEEB (Hidden)

Current School GPA

Program of Interest

Athletic Information

Which games are you interested in playing competitively?

BattleTag/Summoner/Etc. Name(s):
(Please indicate which game/platform)

Preferred Role/Character(s):

Rank:

Discord Account Information:

Any Other Information You'd Like to Share:

HIDDEN: Athletic Interest, Esports

Clicking "Submit" below constitutes your written consent to be called/texted/emailed by Cottey College at the number(s)/address(s) you provided regarding furthering your education.