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 East Mississippi Community College coaches with the necessary information about you and your sports background.  For an application to the college, please visit the EMCC homepage at

Please remember to confirm your form once you hit the submit key, as hitting the submit key only saves your answers until you confirm your form.  If successful, you should receive a confirmation page of the form being submitted.  Thank you again for your interest in EMCC Athletics.


First Name: Last Name:
Address: Birth Date(mm/dd/yy):
City: Home Phone:
State: Cell Phone:
Zip Code: Email:
Twitter Handle: Facebook Link:

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:

School: Graduation Date:
Address: Grade Point Average (GPA):
City: ACT/SAT Score:
State: Counselor Name:
Zip Code: Counselor Phone:

Head Coach: Head Coach Phone:
Head Coach Email:    
Height: Weight:
Offensive Position (Check all played):  QB   C  ATH 
   RB   RG  
   FB  LG  
   WR  RT  
   TE  LT  
Defensive Position (Check all played):   NG  ILB   
   DT  S  
   DE  SS  
   OLB  FS  
   MLB  CB  
Special Teams (Check all played):  PK  LS  
   K  KR  
   P  PR  
Jersey Number: HUDL Link:
YouTube Link: Bench:
Squat: Power Clean:
40 Time: Known Injuries: