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Contact Information

Club Sports Department
Duncan Callahan
(970) 943-3061
dcallahan@western.edu

Office Hours

Escalante Terrace

M - TR

9:30am - 12:30pm

2:30pm - 5:30pm

Prospective Rugby Athlete Questionnaire

Recruiting Questionnaire

This form is not an official university application.

Personal Information

Last Name (Required)

First Name (Required)

Middle Initial

Permanent Address (Required)

City (Required)

State (Required)

Zip (Required)

Home Phone (Required)

Cell Phone (Required)

Your E-Mail Address (Required)

Best way to Contact (Required)

Date of Birth (Required)

Mother's Name

Mother's Occupation

Father's Name

Father's Occupation

High School Name: (Required)

Coach's Name:

Coach's Phone Number:

High School Graduation Year: (Required)

High School Grade-Point Average: (Required)

SAT Score: (Required)

If not taken enter N/A

ACT Score: (Required)

If not taken enter N/A

Height: (Required)

Weight: (Required)

Position (Required)

Stats & Achievements:

Comments (Required)