Farmingdale State Prospective Student-Athlete Form

Men's Soccer
Contact Coach Chuck Schimpf for more information - 631-420-2620 or

Please complete the following information and press the Submit button below.


First Name:

M I:


Last Name:

Home Address:






Home Phone:

   Cell Phone: 

Date of Birth:




Social Security #:

High School/College/Club:

Year of Graduation: 

H.S. Coach Name:

Office Phone:

Home Phone:

Grade Point Average:


College Board Exam Scores

SAT I: Verbal



ACT: Composite



Have you applied to Farmingdale State?          Yes       No

Intended major:


Please indicate any information relative to your athletic performance (i.e., Track Events, Best Performances, Honor/Awards, etc.)

If possible, please forward these items to the address and head coach listed below:


         -          Letter of recommendation from your coach

         -          Game Schedules

         -          Video of athletic performance 

         -          Any other information you feel is important to evaluate your athletic performance

Farmingdale State College
Athletics Department
2350 Broadhollow Road � Nold Hall
Farmingdale, New York 11735