Rider University - Men's Basketball Questionnaire

Fields marked with an asterisk (*) are mandatory

Personal
*Name:
*Nickname:
*Height:
*Home Address:
*City:
*State:
*Zip:
*Cell Phone:
*E-Mail Address:
*Date of Birth (MM/DD/YYYY):
*Lives with:	Parents Guardian Relative Other If other, please specify
*Guardian's Full Name:
*Guardian's Occupation:
*Guardian's Alma Mater:
*Guardian's Work Phone:
*Guardian's Cell Phone:
Brother's/Sister's Names and Ages:
*List your top three deciding factors in choosing a college (i.e., distance, academics, playing time)	1.
	2.
	3.
List two other people who will help you make your college decision
*Name:
*Relationship:
*Phone Number:
*Name:
*Relationship
*Phone:
Academics
*High School:
*High School Phone:
*High School Address:
*Guidance Conselor:
*GPA:
*Date of Graduation:
PSAT Verbal:
PSAT Math:
PSAT Date Taken:
SAT Verbal:
SAT Math:
SAT Date Taken:
ACT:
ACT Date Taken :
*Your Intended Field of Study:
Athletics
*HS Coach's Full Name:
*HS Coach's Home Phone:
*HS Coach's Work Phone:
*HS Coach's Cell Phone:
AAU Team:
AAU Coach's Full Name:
AAU Coach's Home Phone:
AAU Coach's Work Phone:
AAU Coach's Cell Phone:

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