Basketball Questionnaire

Email Secondary Email

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CONTACT INFORMATION

Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Cell Phone Number *

ATHLETIC INFORMATION

High School *

Current Grade Level *

HS Freshman HS Sophomore HS Junior HS Senior College Transfer

Primary Position *

Secondary Position *

Height/Weight

High School Coach's Name *

High School Coach's Cell *

High School Coach's Email *

AAU/Summer Ball Team Name

AAU/Summer Ball Coach's Name

AAU/Summer Ball Coach's Cell *

ACADEMIC INFORMATION

NCAA Clearinghouse Registered *

Yes No

High School Address *

High School City, State, and Zip *

High School Graduation Date

High School GPA

OTHER COLLEGE INFORMATION

Other Colleges Attended *

Hours Completed at Other Colleges *

ADDITIONAL INFORMATION

Have you applied to Pitt Community College? *

Yes No

Any Additional Information

* required field

Men's Basketball