Recruiting Questionnaire

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ZIP Code *

Email address *

City *

Address 1 *

Last name *

State *

First name *

Date of Birth *

Phone Number *

Cell Phone Number *

Mother's Name *

Mother's Email *

Mother's Address *

Mother's City *

Mother's State *

Mother's Zip *

Mother's Occupation *

Mother's Cell *

Father's Name *

Father's Email *

Father's Address *

Father's City *

Father's State *

Father's Zip *

Father's Occupation *

Father's Cell *

Live With *

Mother Father Both

Are you interested in playing basketball after you career at BRCC *

Yes No

Sibling (s) Name (s) *

Other schools recruiting you *

High School *

High School City and State *

High School Phone *

High School Web Site *

High School Graduation Date *

High School GPA *

SAT score *

ACT score *

Intended Major *

Guidance Counselor *

Guidance Counselor Phone *

Guidance Counselor E-mail *

Transfer Student *

Yes No

If yes, Name of school (s) previously attended and dates of attendance *

High School Coach *

High School Coach's Email *

High School Coach's Phone Number *

Height *

Weight *

Position (s) *

Jersey Number *

Points per game *

Rebounds per game *

Assists per game *

Athletic Honors *

Other Varsity Sports Played *

AAU Team name *

AAU Coach's Name *

AAU Coach's Email *

AAU Coach's Cell Phone *

* required field