Athletics Questionnaire

Sport:

Position:

Name:

E-mail:

SSN:

Graduation Date:

Sex:	Male Female	Birth Date:
Age:		Height:
Weight:		Jersey #:

Race:

Religion:

Parents:

Address:

Home Phone:

City:		State:
ZIP:

High School:

H.S. Phone:

H.S. Address:

H.S. Coach:

Coach's Office Phone #:		Coach's Home Phone #:

Junior College:

J.C. Phone:

J.C. Address:

J.C. Coach:

Coach's Office Phone #:		Coach's Home Phone #:

ACT/SAT Score:

Class Rank:

Cumulative GPA:

Entrance Term:

College Major:

Film Available?:

Church Affiliation:

Honors in H.S. or J.C.:

Other Information:

© 2005 Missouri Baptist University | One College Park Dr. | St. Louis, MO | 63141-8698
(314) 434-1115 | (877) 434-1115 | fax: (314) 434-7596
www.mobap.edu/athletics/questionnaire.asp