Thank you for your time in providing information for this form. Please note, this form does NOT serve as an application for the college. This form is to provide Northeast Mississippi Community College coaches with the necessary information about yourself. For an application to the college, please visit the NEMCC Homepage at http://www.nemcc.edu

NOTE: All form boxes that are outlined in red are REQUIRED fields and the form cannot be submitted without filling out those forms. 
 

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PERSONAL INFORMATION      
       
Name Birth Date (mm/dd/yy)
Height Weight
Address Home Phone
City Cell Phone
State Email
Zip Code

       
GUARDIAN INFORMATION      
       
Mother or Legal Guardian Father or Legal Guardian
Occupation Occupation
Address Address
City City
State State
Zip Code Zip Code
Home Phone Home Phone
Cell Phone Cell Phone
Email Email
       
HIGH SCHOOL INFORMATION      
       
School Graduation Date
Address Grade Point Avergae (GPA)
City ACT/SAT Score
State Class Rank
Zip Code Honors
Phone Clubs
       
HIGH SCHOOL ATHLETIC INFORMATION      
       
Coach Other Sports Played
Phone Awards (List all sports)
Email Achievements (List all sports)
       
HIGH SCHOOL STATS      
       
Offensive Position (List all played)  QB   C  ATH 
   RB   RG  
   FB  LG  
   WR  RT  
   TE  LT  
       
Passing Yards Passing Touchdowns
Completions/Attempts Interceptions
Rushing Yards Rushing Touchdowns
Carries Fumbles
Reciving Yards    Receiving Touchdowns 
Receptions Sacks Allowed (linemen only)
Pancake Blocks (linemen only) Video Available?    
       
Defensive Position (List all played)   NG  ILB   
   DT  S  
   DE  SS  
   OLB  FS  
   MLB  CB  
       
Tackles  Forced Fumbles
Tackles for Loss Fumble Recoveries
Sacks Interceptions
QB Hurries Pass Breakups
QB Knockdowns  Video Available?
       
Special Teams (List all played)  PK  LS  
   K  KR  
   P  PR  
       
Field Goals Made Punts
Field Goals Attempted Longest Punt
Field Goals Blocked Average Hang Time
Longest Field Goal Made Downed Inside 20
Extra Points Made Downed Inside 10
Extra Points Attempted Downed Inside 5
Extra Points Blocked Snap Time (long snapper only)
Punt Returns Kickoff Returns
Punt Return Average Kickoff Return Average
Punt Return Touchdowns Kickoff Return Touchdowns
Kickoffs     Video Available?
Kickoff Average        
Kickoff Touchbacks    
       
COMBINE INFORMATION      
       
Combine(s) Attended Vertical Jump
40 Time Bench Max
100 Time Squat Max
       
TRANSFER STUDENTS      
       
College Year in College
Address Grade Point Average (GPA)
City Major
State Reason(s) for Transfer
Zip Code Other Sport(s) Played
       
College Football Stats      
       
Offensive Posistion (List all played)  QB   C  
   RB   RG  
   FB   LG  
   WR   RT  
   TE   LT  
       
Passing Yards Passing Touchdowns
Completions/Attempts Interceptions
Rushing Yards Rushing Touchdowns
Carries Fumbles
Receiving Yards Receiving Touchdowns
Receptions Sack Allowed (linemen only)
Pancake Blocks (linemen only) Video Available?
       
Defensive Position (List all played)  NG  ILB  
   DT  S  
   DE  SS  
   OLB  FS  
   MLB  CB  
       
Tackles    Forced Fumbles   
Tackles for Loss    Fumble Recoveries   
Sacks    Interceptions
QB Hurries    Pass Breakups   
QB Knockdowns Video Available?   
       
Special Teams Position (List all played)  PK  LS  
   K  KR  
   P  PR  
       
Field Goals Made Punts
Field Goals Attempted Longest Punt
Field Goals Blocked Average Hang Time
Longest Field Goal Made Downed Inside 20
Extra Points Made Downed Inside 10
Extra Points Attempted Downed Inside 5
Extra Points Blocked Snap Time (long snapper only)
Punt Returns Kickoff Returns
Punt Returns Average Kickoff Return Average
Punt Return Touchdowns Kickoff Return Touchdowns
Kickoffs Video Available?
Kickoff Average    
Touchbacks