Personal Information

Name:

Date of Birth:

Ex: mm/dd/yyyy

SSN:

Address:

City:

State:

Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Zip:

Phone:

Ex: (###) ###-####

Email:

Mother's Name:

Occupation:

Father's Name:

Occupation:

Education Information

High School:

High School Coach:

Coach's Phone:

Ex: (###) ###-####

Graduation Year:

Junior College:

Coach:

Coach's Phone:

Ex: (###) ###-####

GPA:

SAT:

ACT:

Academic Interest:

Degree:

Other schools recruiting you:

Top three choices in choosing a college:

What schools do you plan to make a recruiting visit to (list top 5)?

Athletic Information

Register with clearing house?

YesNo

If yes, PIN #:

Points:

Rebounds:

Assists:

Athletic Honors/Awards:

Height:

Weight: