Women's Basketball Potential Student Athlete Questionnaire

Please complete the fields below and click "Submit" when you are finished.

Basic Information

Full Name:

Date of Birth:

Home Phone:

Email Address:

Home Address:

City:

State/Province:

Zip:

Country:

Educational Background

High School:

HS Graduation Date:

HS Guidence Counselor:

Junior College:

JC Graduation Date:

JC Guidence Counselor:

Academic Interest

Desired Major at Cheyney:

Class Rank/Size:

GPA:

Combined SAT:

Math SAT:

Verbal SAT:

ACT:

SAT Dates to be Taken:

ACT Dates to be Taken:

NCAA Clearinghouse Registration (Yes/No):

Athletic Information

HS Coach's Name:

HS Coach's Phone:

Junior College Coach:

JC Coach's Phone:

Position:

Height:

Weight:

Experience:

Fresman Team Record:

Sophomore Team Record:

Junior Team Record:

Senior Team Record:

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What camps, tournaments or events will you participate in during the next year? (please list where and when):

Athletics Honors @ Relevant Statistics (please list where and when):

Colleges You are Applying To:

Other Sports Played:

Additional Comments:

Men's Sports