GREATER KANSAS CITY FOOTBALL COACHES ASSOCIATION



FORM DUE NO LATER THAN JANUARY 20th

2021 Scholar/Athlete Nomination Form

Name: ________________________________________________________________

Last First Middle

Permanent Address: __________________________________________ ____________

Street County

___________________________ ____________ ____________

City State Zip Code

Present Telephone: ________ _________________

Area Code Phone number

Name of Father/Guardian: ___________________________________

Place of Employment: _______________________________________

Name of Mother/Guardian: ___________________________________

Place of Employment: _______________________________________

Address of Parents/Guardians (if different from above):

_____________________________________________ _____________________________ _____________ ____________________

Street City State Zip

How many brothers and/or sisters do you have that reside with you?: _______

How many brothers and/or sisters will be attending college next year?: _______

EDUCATIONAL EXPERIENCE:

Name of High School: ____________________________ Graduation Date: ________

ACT Score: _______ SAT Score: _______ Class Rank: _______ 7th Sem. GPA: ______

Approximate number of students in Senior Class: ________________

PLEASE INCLUDE CURRENT TRANSCRIPT WITH APPLICATION

FOOTBALL EXPERIENCE:

Number of Varsity football letters awarded: __________________

List any awards received from your school:

Sophomore: _________________________________________

Junior: _____________________________________________

Senior: _____________________________________________

List any LEAGUE recognition:

Sophomore: _________________________________________

Junior: _____________________________________________

Senior: _____________________________________________

List any KANSAS CITY area awards received:

Sophomore: _________________________________________

Junior: _____________________________________________

Senior: _____________________________________________

List any other football-related awards you have received

Do you plan to attend college: _____________

Do you plan to continue playing football: _________________

If YES, please list your top three choices:

1. ________________ 2. ___________ 3. ___________

If YES, have you received a scholarship offer:

FULL: ______________ PARTIAL: _________________

Please explain below if partial;

Do you intend to WALK-ON: ____________________________________

SCHOOL ACTIVITIES:

List any other extra curricular activities you have participated in during high school, plus the level of participation (what level did you letter in)

Sophomore:____________________________________________________

Junior:_______________________________________________________

Senior:_______________________________________________________

List any honors received in any other sports activity:

Sophomore:____________________________________________________

Junior:_______________________________________________________

Senior:_______________________________________________________

List all activities in which you were selected as a captain:

_____________________ ______________________ _______________________

Briefly describe your future plans for any of these activities:

List any and all academic awards:

List any and all organizations that you have participated in and include any office held:

NON-SCHOOL RELATED ACTIVITIES:

Honor and Awards (i.e., Eagle Scout, etc.). State the nature of the award:

List any other organizations that you belong to (church etc):

Have you been granted any scholarship aide: ______________ If YES please describe:

PLEASE INCLUDE THE FOLLOWING:

1. A letter from the school’s Head Football Coach briefly describing the applicant’s contributions to his high school in the following areas: Scholarship, Citizenship, and Athletics.

2. A letter from the school’s principal briefly accounting for the applicants contributions to his high school in the following areas: Scholarship, Citizenship, and Athletics.

3. A letter from the applicant explaining his goal after graduation.

4. A copy of the applicants 7th semester transcript.

5. All paperwork filled out completely and returned in order.

PLEASE READ AND SIGN THIS FORM:

I/We have reviewed this application and verify to the validity of this information.

Principal: ___________________________________ Date _______________

Head Football Coach _________________________ Date _______________

Return form by January 20, 2021 to:

Grain Valley High School

c/o David Allie, GKCFCA President

551 SW Eagles Parkway

Grain Valley, MO 64029

If you have any questions, please email mhzegunis@

Thanks for supporting the GKCFCA!

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