KCKCC Men's Basketball Questionnaire

Email Secondary Email

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Email address *

Personal Information

Full Name *

Address *

Address

City *

State *

County *

Zip Code *

Home Phone Number *

Cell Phone Number *

Birthdate *

Parent's Information

Father's Full Name *

Father's Email

Father's Cell Number

Father's Occupation

Mother's Full Name *

Mother's Email

Mother's Cell Number

Mother's Occupation

Academic Information

Year of High School Graduation

High School *

Address *

Address

City *

State *

Zip Code *

Guidance Counselor

School Phone Number *

GPA

ACT Score

SAT Score

Major you wish to study

Athletic Information

High School Coach's Name *

High School Coach's Cell Number

High School Coach's Office Number

High School Coach's Email Address *

Height *

Weight

Primary Position *

Jersey Number *

Points Per Game

Rebounds per Game

Field Goal Percentage

3 Point Field Goal Percentage

Free Throw Percentage

AAU/Club Team Name

AAU/Club Team Coach's Cell Number

AAU/Club Team Coach's Email

* required field