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ONLINE QUESTIONAIRE

Date:

Name:
Last: First: MI:

Height: Weight:

Address: City: State: Zip:

Telephones: Email Address:

Date of Birth: Age: Social Security #:

High School: City: State: Zip:

Basketball Coach: Coach's Phone #'s:

GPA: Class Rank: Year of Graduation:


ACT Composite Score: English: Mathematics:
(or date to be taken):

SAT Composite Score: Verbal: Math:
(or date to be taken):

Academic Interests:


Father's Name: Occupation:

Mother's Name: Occupation:

Family Members who are attending,
or who have attended college:


Basketball Information:

Offensive Position(s): Defensive Positions:

# Years Playing/Letters: Video Film Available Schedule Available

PPG: RPG: APG: FG%: FT%:

Honors/Awards:


Link: NCAA
Link: Northwest Conference