Questionnaire - Men’s Basketball - Chadron State College

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Fans

Name and Contact Information
First Name:
Middle Initial:
Last Name:
Mailing Address:
City:
State:
Zip:
Phone Number:
Email:
Best Day to Call:	M Tu W Th F Sa Su Any Day
Best Time to Call:	Morning Afternoon Evening Anytime
Personal Information
Father’s Name:
Father’s Occupation:
Mother’s Name:
Mother’s Occupation:
Parent’s Mailing Address:
Phone Number:
City:
State:
Zip:
Name 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 is only for junior college* athletes**:
Junior College:
P.O. Box or Street Address:
City:
State:
Zip:
Graduation Date:
GPA:
Hours Completed:
*This section is for all* athletes**:
High School:
P.O. Box or Street Address:
City:
State:
Zip:
High School Phone:
High School Graduation Year:
*This section is only for high school* athletes**:
Principal:
Counselor:
Class Rank:
GPA:
ACT Score:
SAT Score:
*This section is for all* athletes**:
Desired College Major(s) or Academic Interests:
Athletic Information
*This section is only for junior college* athletes**:
Junior College Coach:
Coach’s Phone:
*This section is 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:
Free Throw %:
Three Point %:
Assists per Game:
Steals per Game:
Film Available?:	Yes No
Team Record:
Honors:
*This section is only for high school* athletes**:
AAU Program:
AAU Coach:
AAU Coach’s Phone:
*This section is for all* athletes**:
Your level of interest in Chadron State:	Not 1 2 3 4 5 Very
Ask the Coach:
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