Introduction Section
Liberty Men's Basketball Questionnaire
Questionnaire Code
(not required):
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Country:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
Skype:
Google Talk:
FaceBook:
paste the URL from your Facebook profile
Twitter:
@
enter your twitter username only
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 Business Ph.:
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 Business Ph.:
Father'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 Email Address:
Guardian's Cell Phone:
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 Composite:
ACT Composite:
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Athletic Information
Height
Weight (in lbs.)
Jersey #


Positions
Basketball
Other Questions
How many songs are on your iPod?:
What is the best video game ever made and for what system?:
What movie or TV shoe made you shed a tear? (Be Honest!):
If you had a choice who would you rather date than your girlfriend?:
On average, how many text messages do you send per day?:
What is the most played song on your iPod?:
Who are the starting five on your Olympic Dream Team?:
Who is your favorite NBA player and why?:
What NBA player's skill set is most comparable to yours and why?:
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: