Western Illinois University- Quad Cities Esports Recruitment Form

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Full Name *

Email Address (WIU Email if applicable) *

Phone Number *

Address *

City *

In What State Do You Currently Reside? *

Please indicate your current or future status as a WIU student *

I am currently a WIU student

I am not currently a WIU student but plan to enter WIU as a freshman

I am not currently a WIU student but plan to enter WIU as a transfer student

Other:

Which campus are you interested in, considering, or currently attending? *

Quad Cities Campus in Moline, IL

Macomb Campus

Both

Online

Other:

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