Men's Basketball

Prospective Student Athlete Questionnaire

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Cell Phone

Email *

Birthdate (MM/DD/YY)

Height

Weight

High School Graduation Year

High School Grade Point Average

Applied to NCAA Clearinghouse?

Yes
No

Been Admitted to UVa?

Yes
No

Parent 1 Name *

First

Last

Parent 1 Cell Phone

Parent 1 Email *

Parent 2 Name *

First

Last

Parent 2 Cell Phone

Parent 2 Email *

Athletic Experience

High School

High School Address

Address Line 1

City

State

Zip Code

Position

High School Jersey Number

High School Coach's Name *

First

Last

High School Coach's Cell Phone

Statistics for Current Season

Career Statistics

Club Team Name

Club Team Coach's Name *

First

Last

Club Team Coach's Cell Phone