Welcome to Western Carolina Men's Basketball
Prospective Student Athelete Questionnaire

Please fill out the following questionnaire
Click the SAVE button below when you're done.
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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. 2011)

 

Personal Information
 
Today's Date:
Your Name:
First Middle Last
Preferred Name:
Street Address:
City:
State / Zip:
Western Carolina People You Know:
Relatives In North Carolina:
Date of Birth:
Month Day Year
Email Address:
Instant Messenger:
Home Phone:
Cell Phone:
Family/Friends who attended Western Carolina:
 

Parent's Information
 
Mother's First Name:
Mother's Last Name:
Mother's Job:
Mother's College:
Mother's Home #:
Mother's Work #:
Mother's Cell #:
Mother's Address:
City:
State / Zip:
Parents are:
Brothers/Sisters (Full Names and Ages):
Father's First Name:
Father's Last Name:
Father's Job:
Father's College:
Father's Home #:
Father's Work #:
Father's Cell #:
Father's Address:
City:
State / Zip:
Person(s) you live with:
Other Name(s):
Other Relationship:
 

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:
PSAT:
SAT Test Date: Score:
ACT Test Date: Score:
Class Rank:
List the areas of college study you think you would like to major in.
Counselor's First Name:
Counselor's Last Name:
Counselor's Phone:
 

HS/JC Athletic Info
 
Coach's First Name:
Coach's Last Name:
Coach's Office #:
Coach's Home #:
Coach's Cell #:
Coach's College:
Coach's Home Address:
Coach's City:
Coach's State / Zip:
 

AAU/Summer Athletic Info
 
AAU Team:
Coach's First Name:
Coach's Last Name:
Coach's Home #:
Coach's Cell #:
Coach's Home Address:
Coach's City:
Coach's State:
Coach's Zip:
 

Athletic Stats
 
Height:
Weight:
Jersey Number:
Position:
Shoe Size:
Please list, in order, the top four universities of your choice.
Please list, in order, the top four factors in choosing a university.
Best individual opponent:
Opponent's school:
List two other people who will help you make college decision:
1. Name:
Relationship:
Phone:
Address:
City:
State / Zip:
2. Name:
Relationship:
Phone:
Address:
City:
State / Zip:
 

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