LYCOMING COLLEGE

Men's Basketball Questionnaire

General Infomation

Name:

Email:

Home Address:

City:

State:

Zip code:

Home Phone:

Cell Phone:

Date of Birth:

SS#

Father's Info:

Name:

Occupation:

Bus. Phone:

Mother's Info:

Name:

Occupation:

Bus. Phone:

Academic Infomation

High School

Address:

Academic Interests:

SAT Scores:

Verbal

Math

Written

Date Taken

Class Rank/Total

GPA

Date of Graduation

Athletic Information

High School Coach Info:

Name: Coach's Home Phone:

Height:

Weight:

Position:

Jersey Number:

Points Per Game:

Rebounds Per Game:

Assists Per Game:

Years as a Starter (including senior year)

Awards (Captain, All-Conference, etc.)

Friends/Relatives attending or graduates of Lycoming

To ensure the security of this form, please type the following numbers into the text box exactly as they appear: