IPFW Basketball Questionnaire
Name:
Birthdate Height Weight
Address: City State Select a State Here Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip Home Phone
Father's Name Occupation Mother's Name Occupation
High School: Name: Conference/League
Address: City State Select a State Here Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip School Phone
Coach's Name Home Phone Work Phone
Positions Played Point Avg Rebound Avg Assists
High School Counselor Work Phone
Athletic Achievements and Honors (Record held, "All - Teams, All-Star games, Captain etc.):
Other Sports Played (Year, Sport, Position/Event):
Your Current Year Fr So Jr Sr
GPA Class Rank Graduation Date
College Major Colleges Interested In
SAT Score ACT Score Will you qualify for financial aid? Yes No
Other Information and or Requests:
