Please fill out the following form if you have an interest in playing women's basketball  for
North Carolina A&T. This is not an official N.C. A&T University application, but is merely designed
 to gauge your interest in the program.     

GENERAL INFORMATION                            

First  Name   Middle Initial         

Last Name  

Address       
                   

City        
State      Zip

Home Phone        
E-Mail Address       
DOB      Age      

Church Preference

Grade (Current)     
Year of Graduation  

Father's Name    
Occupation      

Mother's Name       
Occupation       

Mother and Father's Office Phone

ACADEMIC INFORMATION

Overall GPA     Core GPA         Class Rank  

Guidance Counselor's Name       
SAT (Math/Verbal/Total)     ACT  

  PSAT Score (Verbal/Math)

Guidance Counselor's Phone

Date Taken

Registered with NCAA Clearinghouse (Yes/No)  
PID #  

High School/Junior College       
Coach's Name      

School Address       
                   

School Fax 

City                   
State          Zip

Coach's Office Phone           

Coach's Home Phone

Coach's Address

Coach's E-Mail

If you are a Junior College transfer, will you graduate?     
Junior College GPA    

  College Major Desired     
Your Second Choice      
           

BASKETBALL INFORMATION
Left-or-Right Handed?        Position       

Statistics for current season       

Best Player you have faced

Games Played        Points per Game      

Height        Weight      

Field Goal Pct. 3-Point FG Pct.

Free Throw Pct. Rebounds Per Game

Assists Per Game   
Honors & Awards  


Who has been most influential
in your athletic career? 

Other Data

Do you know anyone who is or has been enrolled at North Carolina A&T University?

Have you applied for admission?       
Have you visited the campus?