PIONEER MEN'S BASKETBALL QUESTIONNAIRE
PERSONAL INFORMATION
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* Last Name:
*First Name:
* Address:
*City:
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* Zip:
* Age:
* Birth date: (00/00/00)
* SSN:
* Home Phone Number:(
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Cell Phone: :(
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*Email Address:
SCHOOL INFORMATION:
School Name:
School Address:
School City:
School State:
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AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
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VA
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School Zip:
Graduation Year:
GPA:
( 4.0 Scale) ACT:
SAT:
Class Rank:
ATHLETIC INFORMATION:
Height:
5
6
7
Ft.
1
2
3
4
5
6
7
8
9
10
11
Inches
Weight:
Points Average:
Rebound Average:
Assists Average:
Position Played:
Coach:
Coach Phone Number: (
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