LCC Women's Basketball Prospective Student-Athlete Questionnaire

LCC Women's 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:

High School:

School Phone:

HS Address:

City:

State:

Zip:

HS Coach:

HS Coach Phone:

Cell Phone:

2. Athletics

Primary Position:

Secondary Position:

Statistics:

Other Information:

For more information please contact:

Farrah Owens, Head Women's Basketball Coach
Lenoir Community College
P.O. Box 188
231 Hwy. 58 South
Kinston, NC 28502-0188
Phone - 252-527-6223, ext. 201
Fax - 252-233-6879