LCC Basketball Prospective Student-Athlete Questionnaire
Please answer the questions below, when finished click the Submit button.
Form works best with Internet Explorer - you still have the option to print,
fill-out and mail to the address below.

1. General Information

First Name: Middle: Last Name:
Address: City: State: Zip:
Home Ph: Cell Ph: Email Address:
Date of Birth: Graduation Date: Age:
High School: School Phone:
HS Address: City: State: Zip:
HS Coach: HS Coach Phone: Cell Phone:
Parents Name: Parents Phone #:
Career Major: GPA: Class Rank: out of
SAT Score Total: Verbal: Math: ACT Score:

2. Athletics

Height: Weight: Playing Number:
Playing Position: L or R Handed:
Statistic/Honors:

Other Information:



For more information please contact:

Bobby Dawson , Head Basketball Coach
Lenoir Community College
P.O. Box 188
231 Hwy. 58 South
Kinston, NC 28502-0188
Phone - 252-527-6223, ext. 206
Fax - 252-233-6879