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Personal Information

Name

Birth Date

Home Address

City

State

Zip

Home Phone (with area code)

Cell Phone (with area code)

Email Address

Instant Messenger Address

Father's/Guardian's Name

Father's/Guardian's Occupation

Mother's/Guardian's Name

Mother's/Guardian's Occupation

Siblings Names and Ages

Any relatives who have or are currently participating in college or professional athletics
List the name, relationship to you, sport involved, school and years, if possible.)>

Previous School Information

High School

High School Address

High Coach's Name

High Coach's Phone Number

Junior College/4-Year Institution

Junior College/4-Year Institution Address

JC/4-Year Coach's Name

JC/4-Year Coach's Phone Number

Eduational Information

Graduation Date

Grade Point Average

Intended College Major

PSAT

SAT

ACT

Club Basketball Information

Club Team

Club Coach

Club Coach's Phone Number

Basketball Athletic Information

Height

Position(s)

List Athletic Honors

Other sports you participate in:

Scoring Average

Rebound Average

Assist Average

Steal Average

Tell Us About...

Why you are considering Oregon State?

What other schools are you considering?

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