Athletic Prospect Questionnaire - Women's Basketball

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Wayne State College
1111 Main Street
Wayne, NE 68787
1-866-WSC-CATS (972-2287)
or 402-375-7234
e-mail: admit1@wsc.edu

Athletic Prospect Questionnaire

Women's Basketball

Full Name:

Email:

Phone:

Address:

City:

State:

Zip:

Date of Birth:

Social Security #:

Graduation Year:

Anticipated Major:

SPORT Related Information:

Position:
Height: Weight:
Scoring Avg: Rebound Avg: Assist Avg:
Field Goal %: Free Throw%:
Other Sports
Athletic Honors

Parent Information:

Father's Name:

Address: (Include City, State, Zip)

Phone:

Occupation:

Mother's Name:

Address: (Include City, State, Zip)

Phone:

Occupation:

School Information:

Present School :

Address: (Include City, State, Zip)

Coach:

Coach's Phone:

High School Counselor:

Counselor's Phone:

G.P.A.

Class Rank:

ACT/SAT Score:

Academic Honors/Honors

Junior College :

Freshman Sophomore

Division/Class

Jr College Grad Year

Have you applied for financial aid?
Yes: No:

Do you qualify for financial aid?
Yes: No:

Admissions Home

General Info: 800-228-9972 OR Admissions: 866-WSC-CATS

E-mail: webmaster@wsc.edu

Member, Nebraska State College System