PERSONAL INFORMATION
Full Name_____________________________
Phone Number_________________________
Address_______________________________
City__________State_____________Zip____
Social Security Number____________________
Birthday________________________________
Email__________________________________
Father's Name___________________________
Fathers Occupation_______________________
Mother's Name__________________________
Mother's Occupation______________________
ACADEMIC INFORMATION
Highschool______________________________
Graduation Year__________________________
School Address___________________________
City___________State_____________Zip______
Counselor's Name________________________
Counselor's Phone Number_________________
Grade Point Average_______________________
ACT Score____SAT Math ____SAT Verbal____
Academic Honors or Awards_________________
________________________________________
ATHLETIC INFORMATION
Height________________Weight_______________
Positions__________________________________
Game Averages: Points___Rebounds____Assists____
Team Record_______Division__________________
Coach's Name______________________________
Coach's Phone Number__________________(home)
__________________(cell)
Best time to call_____________________________
Club/Traveling Team_________________________
Coaches Name_____________________________
Coaches Phone Number__________________(home)
__________________(cell)
Other sports played__________________________
Athletic Awards/Honors_______________________
_________________________________________
COLLEGE INTREST INFORMATION
Interest in Cal Poly Pomona: ___excellent__good___fair
What do you want to major in?___________________
Top three college choices1)______________________
2)__________________ 3)_____________________
SEND QUESTIONNAIRES TO:
Cal Poly Pomona Women's Basketball
3801 West Temple Avenue
Pomona , CA 91768
(909)869-2824 (office number)
(909)869-2814( fax number)
