Introduction Section
Please complete the questionnaire as thoroughly as possible. Leave unknown answers blank. Once submitted you can expect a response within seven days. Thank you.
Questionnaire Code
(not required):
Personal Information
First Name:
Last Name:
Preferred Name:
Country:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
What is your connection to this university:
Parent(s) Information
Mother's First Name:
Mother's Last Name:
Mother's Occupation:
Mother's Email Address:
Mother's Cell Phone:
Mother's College:
Living With:
Siblings (Names & Age):
Father's First Name:
Father's Last Name:
Father's Occupation:
Father's Email Address:
Father's Cell Phone:
Father's College:
Living With:
Most Influential People in Your Life: (1)
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Guardian's Zip:
Gender:
Guardian's Email Address:
Guardian's Cell Phone:
Living With:
Academic Information
School Name:
School Address:
School City:
School State:
School Zip:
School Phone#:
School Fax#:
Counselor's First Name:
Counselor's Last Name:
Counselor's Phone:
Counselor's Fax:
Counselor's Email:
GPA:
SAT Test Date:
SAT Reading:
SAT Math:
SAT Writing:
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:
Athletic Information


Other Questions
Strongest part of your game? Why?:
Weakest part of your game? Why?:
Reference 1 Name and Phone:
Reference 1 Relationship:
Reference 2 Name and Phone:
Reference 2 Relationship:
Reference 3 Name and Phone:
Reference 3 Relationship:
When you have completed this questionnaire please click submit questionnaire.
School Name:
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: