Questionnaire

Personal Information
First Name	M.I.	Last Name
Home Address	P.O. Box or Street Address	City
	State	Zip
Current Address	P.O. Box or Street Address	City
	State	Zip
Home Phone	Additional Phone	E-mail Address
Date of Birth	Hobbies	Other Sports
Family Information
Father or Guardian	Name
Address (if different)	P.O. Box or Street Address	City
	State	Zip
Additional Phone	Occupation	College Attended
Mother or Guardian	Name
Address (if different)	P.O. Box or Street Address	City
	State	Zip
Additional Phone	Occupation	College Attended
Names and ages of brothers, sisters
Do you know a CSC alum or current student?	Who is assisting you in your college choice?
Academic Information
This section for only junior college athletes
Junior College	P.O. Box or Street Address
City	State	Zip
Graduation Date	GPA	Hours Completed
This section for all athletes
High School	P.O. Box or Street Address
City	State	Zip
High School Phone	High School Graduation Year
This section for only high school athletes
Principal	Counselor	Class Rank
Grade Point Average	ACT Score	SAT Score
This section for all athletes
Desired College Major(s) or Academic Interests
Athletic Information
This section for only junior college athletes
Junior College Coach	Coach's Phone
This section for all athletes
High School Coach	Coach's Work Phone	Coach's Cell Phone
Use data from most recent year of competition
Position(s)	Height	Weight
Vertical_Jump	Jersey Number
Points per Game	Rebounds per Game	Field Goal %
Free Throw %	Three Point %	Assists per Game
Steals per Game	Film Available? Yes No	Team Record
Honors
This section for only high school athletes
AAU Program	AAU Coach	AAU Coach's Phone
This section for all athletes
Your level of interest in Chadron State:	Not 1 2 3 4 5 Very
Ask the Coach

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