Women's Basketball Questionnaire

Personal and Academic Information:

Full Name: Social Security Number: E-mail Address:
Permanent Address: City, State and ZIP: Home and Cell Phone Numbers:
Birth Date (MM/DD/YYYY): Height: Weight:
Parent/Guardian's Name(s): Parent/Guardian's Occupation(s): Name of High School:
High School Address: City, State and ZIP: High School Phone Number:
High School Coach's Name: H.S. Coach's Phone Number: Grade Point Average:
High School Graduation Date: Rank in Class: Areas of Academic Interest:
ACT or SAT Score: Academic Awards/Honors/Etc: Hobbies:

Basketball Information:

Playing Position: Point Average: Rebound Average:
Assist Average: Shoe Size : Jersey Size :
High School Coach's Name: H.S. Coach's Phone Number: Other Coaches' Names:
Other Coaches' Phone Numbers: Basketball Awards: Other Athletic Awards:

List the three best players you have played against, along with the names of their schools:

Not Greatly Interested

Send a VIDEO TAPE of yourself in BASKETBALL ACTION to:
Barton County Community College
Women's Basketball Office
245 NE 30th Road
Great Bend, KS 67530

(Video tapes will be returned when evaluation is complete.)

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