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Online Questionnaire

Personal Information:
Today's Date: PLEASE USE THE MM/DD/YYYY DATE FORMAT (example: 07/18/2006)
Name: First: Middle: Last: Social Security #:
Address: Street: City: State: Zip: Phone #:
Email: Birthdate:
Church Affiliation:
Entering Semster:               Year: Intended Major:
       
School Name: School Phone #:
School Address:       Street: City:
                               State: Zip: 		ACT Score:
SAT Score:
Graduation Date: GPA: Class Rank:
Counselor's Name: Counselor's Phone #:

Parents:

      
Father's Name First: Last: Mother's Name: First: Last:
Father's Occupation: Mother's Occupation:
     

Basketball Information:
Position: Weight:            Height: ' "         
Film Available:  
Jersey #:  
Coach's Name: Coach's Phone #:

Additional Information:
Athletic Honors:
       
Serious Injuries: Which other sports do you participate in?



     
KWU Student(s) you know: KWU Alumni you know:
   

 
   
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