Introduction Section
Kent State Women's Basketball Questionnaire
Questionnaire Code
(not required):
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 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:
Most Influential People in Your Life: (1)
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Gender:
Guardian's Email Address:
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:
Counselor's Phone:
GPA:
SAT Test Date:
SAT Composite:
ACT Test Date:
ACT Composite:
TOEFL:
Class Rank:
Out Of
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Club Information
Club Name:
Athletic Information
Height
Weight (in lbs.)
Jersey #




Positions
Basketball
Basketball
Other Questions
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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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