Introduction Section
Thank you for your interest in Palm Beach Atlantic University and our women's basketball program. By filling out the questionnaire completely, you will not only help the coaching staff contact you regarding participation in women's basketball, but also begin the process of reviewing your academic information as a part of your application to attend Palm Beach Atlantic University.

Choosing a college is a tremendous journey in a student athlete's career. We at Palm Beach Atlantic University are honored that you have chosen to include us in your search.

I look forward to speaking with you further!


Manisha Redus, Head Coach
Manisha_Redus@pba.edu
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Country:
Address Type:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
Skype:
FaceBook:
Twitter:
@
Instagram:
@
What is your connection to this university:
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
Parent 1's Address (If Different):
Parent 1's City:
Parent 1's State:
Parent 1's Zip:
Parent 1's Occupation:
Parent 1's Email Address:
Parent 1's Cell Phone:
Parent 1's College:
Living With:
Siblings (Names & Age):
Parent 2's First Name:
Parent 2's Last Name:
Parent 2's Gender:
Parent 2's Address (If Different):
Parent 2's City:
Parent 2's State:
Parent 2's Zip:
Parent 2's Occupation:
Parent 2's Email Address:
Parent 2's Cell Phone:
Parent 2's College:
Living With:
Most Influential People in Your Life: (1)
Most Influential People in Your Life: (2)
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Guardian's Address (If Different):
Guardian's City:
Guardian's State:
Guardian's Zip:
Gender:
Guardian's Occupation:
Guardian's Cell Phone:
Living With:
Academic Information
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School Name:
School Address:
School City:
School State:
School Zip:
School Phone#:
School Fax#:
Counselor's First Name:
Counselor's Last Name:
GPA:
SAT Test Date:
SAT Reading:
SAT Math:
SAT Composite:
ACT Test Date:
ACT Sum Score:
ACT Composite:
ACT English:
ACT Math:
ACT Reading:
ACT Science:
TOEFL:
Class Rank:
Out Of
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Club Information
Club Name:
Club Address:
Club City:
Club State:
Club Zip:
Club Coach:
Club Coach Cell:
Club Coach Office:
Club Coach Home:
Club Coach Email:
Athletic Information
Height
Weight (in lbs.)
Jersey #
Positions
Other Questions
Church name:
Denominational Affiliation:
Have you accepted Jesus Christ as your personal Savior? Please explain:
What does Romans 3:23, "For all have sinned and fall short of the glory of God..." mean to you?:
What does John 3:16, "For God so loved the world that he gave his one and only son, that whoever believes in him shall not perish but have eternal life" mean to you?:
Briefly describe any church, mission or non-profit volunteer opportunities you have been involved with:
In what ways will your faith be reflected on the field or court?:
When you have completed this questionnaire please click submit questionnaire.
School Name:
OR :
State:
City:


Club Name:
Team Name:
Coach Last Name:
State:
City:


Club Name:
Team Name:
Club State:
Club Coach First Name:
Club Coach Last Name:
Club Coach Email:
Club Coach Mobile:

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