Interested Men's Lacrosse Prospect Form

Email Secondary Email

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Are you currently enrolled at UCNJ? Or, will you be a new student at UCNJ? *

Currently Enrolled New Student

First Name: *

Last Name: *

Phone Number: *

Email address *

Gender: *

Male Female

Position(s): *

Attack Midfielder Defense Goalie

High School: *

High School Graduation Date? *

(Month/Year)

City: *

(Where you currently reside)

State: *

Zip Code: *

Have you ever attended another College/University? If yes, where?

* required field