Initial Athlete Questionnaire

CONTACT INFORMATION

Email address *

First Name *

Middle Name

Last Name *

Graduation Date

xx/xx/xxxx

Street Address *

City *

State *

Zip Code *

Home Phone

Cell Phone

Date of Birth *

xx/xx/xxxx

PARENT/GUARDIAN AND FAMILY INFORMATION

Father's Name

Mother's Name

Other Contact/Relationship

Father's Occupation

Mother's Occupation

Father's Alma Mater

Mother's Alma Mater

I currently live with:

Mother Father Both Other

Names of siblings

SCHOOL INFORMATION

High School /Transfer

School Phone

School Street Address

City

State

Zip Code

Name of High School Coach

Coach's Cell Phone

GPA

ACT Score

SAT Score

Major

Class Rank

Do you qualify for financial aid?

Yes No Not sure

Name of High School Counselor

High School Counselor's Phone

ATHLETICS INFORMATION

Please select the sport(s) you are interested in

Check all that apply

Men's Basketball Women's Basketball Baseball Softball

How many years have you played each sport selected above?

What position do you play in each sport selected above?

I am...

Left handed Right handed Both

Height

Weight

Vertical Jump (inches)

Shoe Size

Jersey Size

Name of Summer Team

Position played in summer team

Summer Team Coach

Summer Team Coach's Cell Phone

Summer Team Coach's Email Address

Please list any awards you've earned

Please list the top four schools you are interested in attending

Is there anything else you'd like to tell us about yourself?

Thank you for your interest in Brunswick Community College Athletics. We will contact you soon. In the meantime, please email us at athletics@brunswickcc.edu with any questions. Go Dolphins!

* required field