WELCOME TO SOUTHERN ILLINOIS MEN'S BASKETBALL QUESTIONNAIRE
Please fill out the following questionnaire
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Please be sure to fill out all required fields:
First Name, Last Name, Select School, H.S. Grad Year (e.g. 2005)

Men's Basketball Home Page

 

Personal Information
 
Your Name:
First Middle Last
Preferred Name:
Street Address:
City:
State / Zip:
Date of Birth:
Month Day Year
Age:
Email Address:
Home Phone:
Cell Phone:
Student, Family and Friends at SIU:
 

Parent's Information
 
Mother's First Name:
Mother's Last Name:
Mother's Job:
Mother's College:
Mother's Email:
Father's First Name:
Father's Last Name:
Father's Job:
Father's College:
Father's Email:
Brothers and Sisters (please give ages):
If you are not living with both parents, please complete:
Guardian's First Name:
Guardian's Last Name:
Guardian's Address:
Guardian's City:
Guardian's State / Zip:
Guardian's Phone:
 

Academic Information
 
Please use the SELECT SCHOOL Button to choose your school.
School Type:
School Name:
School Address:
School City:
School State / Zip:
School Phone #:
School Fax #:
Graduation Year: GPA:
SAT Test Date: Score:
ACT Test Date: Score:
Class Rank:
Academic Interest 1:
Academic Interest 2:
Counselor's First Name:
Counselor's Last Name:
 

HS/JC Athletic Info
 
Coach's First Name:
Coach's Last Name:
Coach's Office #:
Coach's Home #:
Coach's Cell #:
Coach's Email:
 

AAU/Summer Athletic Info
 
AAU Team:
Coach's First Name:
Coach's Last Name:
Coach's Office #:
Coach's Home #:
 

Athletic Stats
 
Position:
Jersey Number:
Points/Game:
Assists/Game:
Rebounds/Game:
Is Film Available?
Height:
Weight:
Would You Be Interested In Attending SIU If Offered A Scholarship?
When Will You Select A College?
 

When you have completed this questionnaire please click the save button.