Introduction Section
Questionnaire Code
(not required):
Personal Information
First Name:
Last Name:
Preferred Name:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
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 Address (If Different):
Mother's City:
Mother's State:
Mother's Zip:
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 Address (If Different):
Father's City:
Father's State:
Father's Zip:
Father's Occupation:
Father's Email Address:
Father's Cell Phone:
Father's College:
Living With:
Academic Information
School Name:
School Address:
School City:
School State:
School Zip:
School Phone#:
Counselor's First Name:
Counselor's Last Name:
Counselor's Phone:
Counselor's Email:
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Athletic Information
Height
Weight (in lbs.)
Jersey #
Positions
Offense
Defense
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: