Men's Rugby Inquiry Form

Trine University Men’s Rugby – Recruitment Questionnaire

Head Coach: Danny Breda
Email: bredad@trine.edu Cell: 443-340-6581

Student Information

Preferred Name

First Name

Last Name

Birthdate

Email Address

Cell Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Guardian Information

Mother/Father/Guardian Name

Mother/Father/Guardian Phone Number

Mother/Father/Guardian Email Address

Enrollment Information

Type of Student:
Select First Year if you are still in high school and/or completed high school, but never attended college.
Select Transfer if you have ever enrolled in ANY college degree program after high school graduation.

Type of Student

First Year Student

Transfer Student

Intended Academic Entry Term

Intended College Major

Education Information

College/University

College Cumulative GPA

High School

High School Cumulative GPA

Athletic Information

Height

Weight

Primary Position

Secondary Position

Years of Rugby Played

Other Sports Played

Current Team

Rugby Honors, Awards, Achievements

Coach Name

Coach Contact (Email or Phone)

Highlight Film Link

Thank you for your interest in Trine University Men’s Rugby.