Basketball Prospective Form

Personal Information

First Name:____________________ Last Name:__________________ MI:______

Address:___________________________________________________________

City:________________________________ State:___________ Zip:__________

Email:______________________________________ Cell Phone:_____________

Parents Name(s):____________________________________________________

Parents Phone Number:_______________________________________________

Year of Graduation:__________ High School:______________________________

High School GPA:________ HS Coach:___________________________________

High School Coach’s Number:___________________________________________

Last School Attended (if any):____________________

College GPA (if any):___________ College Credit Hours (if any):______________

Primary Academic Interest:____________________________________________

How did you hear about us:____________________________________________

Interest Level: 1 2 3 4 5 (5=highest) (circle One)

 Statistics

Height:______________ Weight:____________ Date of Birth:________________

Position(s):__________________ PPG:_____ RPG:_____ APG:______ SPG:_____

Games Played:_____________ 40 Yard Time:____________ Vertical:__________

Shooting Hand: L R

 Awards/Honors:______________________________________________________

___________________________________________________________________

___________________________________________________________________

Please Return To:

PHCC Athletics
Attn: Kenny Wade/Men’s Basketball Office
645 Patriot Ave.
Martinsville, VA 24112