Women's Basketball
Questionnaire Form

Personal Information

Full Name:____________________________        Social Security No. ____________________

Address:______________________________       Home Phone             (____)_______________

City, State, Zip: _________________________      Date of Birth           ____________________

Mother's Name: ________________________      Business Phone     (____)________________

Father's Name:_________________________        Business Phone     (____)_______________

E-Mail Address: ________________________

Academic Information

High School ____________________________          Phone              (____)_________________

Address        ___________________________          Guidance Counselor _________________

City, State, Zip _________________________          GPA                    ________

Graduation Date ________________________          Best Score on SAT:    M_____  V_____

College(s) attended

1)  ______________________ Dates ___________ Hrs. Completed with "C" or better ______

                                                                                                                                            GPA __________

2) ______________________ Dates ____________ Hrs. Completed with "C" or better ______

                                                                                                                                            GPA __________

Expected Major at Winthrop ____________________________________

Athletic Information

Height _______  Weight _______  Position ____________________________

HS Coach ________________________  HS Coach Address ___________________________

HS Coach Phone: Home- (____)__________________ Work- (____)_____________________

Summer Team _______________________________ Summer Coach ___________________

Summer Coach Address _______________________________________________________

Summer Coach Phone : Home- (____)______________ Work- (____)____________________

Basketball Awards & Honors ______________________________________________________

___________________________________________________________________________

Please return to: Cheryl Nix, Women's Basketball Office, Winthrop University, Rock Hill, SC 29733
Phone 803-323-2129, Ext. 6232; FAX: 803-323-2303; E-mail: nixc@winthrop.edu

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