Introduction Section
Please note that, due to NCAA rules, we can only respond via email or phone call after June 1st at the end of your sophomore year. You may call a UCLA coach at any time, but we cannot return your call until June 1st at the end of your sophomore year of high school.
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:
Mobile Number:
Twitter:
@
Instagram:
@
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
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 Occupation:
Parent 2's Email Address:
Parent 2's Cell Phone:
Parent 2's College:
Living With:
Academic Information
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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:
GPA:
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
Jersey #
Positions
Basketball
Basketball
Other Questions
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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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