Basketball Potential Player Questionnaire
Illinois Valley Community College
Attention: Women's Basketball
815 N. Orlando Smith Avenue
Oglesby, IL 61348 Please print or write legibly.
Or e-mail to cinotte1@comcast.net
Name: _______________________________________________________________
(Last) (First) (Middle)
Personal Information
Home Address _____________________________________________________
City _____________________________State _________Zip _______________
Date of Birth _____________ E-mail Address ______________________________
Cell Phone ____________________Home Phone __________________________
Social Security Number ______-_______-_______ Year of Graduation __________
High School __________________________School Phone ___________________
Coach's Name ________________________Home Phone ____________________
Parent's or Guardian __________________________________________________
Occupations _______________________________________________________
Other Children in your family and age(s) ___________________________________
Friend's or Alumni at IVCC that you know? ________________________________
Other Schools that you are considering? ___________________________________
Athletic Information
Position________Height______Weight______Pts./Game_______
Reb./Game Asst./Game________
Ft%______FG%______3Pt.%_____Position you would like to play in college? ________
Jersey #_____Shoe Size _____Which is your dominant hand, Left or Right?__________
Name of the most influential person in your life__________________________________
List of Honors and Awards________________________________________________
Name of the best player you played against?____________________________________
Her High School_________________________________________________________
List of your strengths as a player_____________________________________________
Weakness______________________________________________________________
List your future goals______________________________________________________
Academic Information
Rank in Class_________GPA_______ACT Score_______SAT Score_________
Are you registered with the NCAA Clearinghouse?______Are you a NCAA Qualifier?______
What would you like to major in?______________________________________________
Other college(s) attend_____________________________________________________
Counselor's Name__________________________Office Phone____________________
Principal's Name_________________________________________________________
Date Completed ___________________
*Please note: Effective Fall 2013 all student athletes will be required to have primary
health insurance. If you do not have primary insurance, please contact the Head Coach
and he will give you additional information regarding this matter.