Prospective Women's Basketball Student-Athlete Information

Thank you for your interest in Linn-Benton Community College women's basketball! Please complete the information below so that we can learn a little more about you. We will be in contact with you shortly.

CONTACT INFORMATION

Email address *

First Name *

Middle Initial *

Last Name *

Date of Birth *

Enter as mm/dd/yyyy

Cell Phone *

Enter as 555-555-5555

Home Address *

City *

State *

Zip Code *

PARENT / GUARDIAN INFORMATION

Parent / Guardian 1

Full Name

Occupation

Parent / Guardian 2

Full Name

Occupation

Parent / Guardian Contact Phone(s)

Enter as 555-555-5555

I live with:

Both Parents / Guardians Parent / Guardian 1 Parent / Guardian 2

ACADEMIC INFORMATION

High School Name *

High School City, State

Cumulative GPA *

Have you taken any courses for college credit?

Yes No

Graduation Date *

Are you registered with an Eligibility Center?

NCAA NAIA None

Your Eligibility Center ID

What academic major area is of interest to you?

Agriculture Business Education & Social Services Health, Healthcare & Nutrition & Culinary Applied Industrial Technology & Transportation Arts & Humanities Science, Engineering, Math & Computer Science Other (specify below)

Other academic interest

Are you interested in our degree partnership program with Oregon State University?

Yes No Not sure

What other colleges are you considering?

ATHLETIC INFORMATION

Height *

Weight

Dominant Hand *

Right Left

Positions played *

Preferred position

Other sport(s) participation

High School coach's name *

High School uniform number

AAU/Club Team name

AAU/Club Team coach's name

AAU/Club Team coach's email

AAU/Club Team uniform number

Link(s) to game or highlight video

Ex: https://myvideohost.com/me

* required field