League of Legends Interest Form

Personal Info

First Name*

Last Name*

Preferred Name

Gender

Birthdate*

Mailing Address*

Country

Street

City

Region

Postal Code

Phone (Home)

Phone (Mobile)

I give permission to Illinois College to send me important updates
via text messaging. (Standard message charges apply.)

Yes

Email Address*

Discord ID

Academic Information

I will enter college as a*

Start Term*

High School Name*

High School Graduation Year*

College Name*
(required only if a transfer student)

Primary Academic Interest*

Secondary Academic Interest

In-game Information

Summoner Name*

Preferred Role*

Secondary Role*

Top 3 Champion Pool*

Current League*

Current Division*

Current Level

While not required, please share a link to game play of yourself in your primary role (YouTube, Twitch, etc.). This will help our staff in our scouting process. Leaving this blank will not diminish our consideration of you for the IC Esports program.