Men's Basketball

Email Secondary Email

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Email address *

Survey for interested student-athletes participating in men's basketball.

Personal Information

First Name *

Last Name *

Height (ft in)

Weight (lbs.)

Bithdate (Month/Day/Year)

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone Number *

E-mail *

E-mail verify *

Can a basketball coach contact you?

Yes No

Father's Full Name

Father's Phone Number

Mother's Full Name

Mother's Phone Number

Brothers (please include names and ages)

Sisters (please include names and ages)

Academic Information

High School Name *

High School Conference

High School Coach Name

High School Coach's Email

High School Coach's Phone #

Graduation Year

Grade Point Average (GPA)

ACT Score

SAT Score

Intended Major

What Semester Will You Begin At Eureka?

Athletic Information

Position *

Point Guard Shooting Guard Wing Power Forward Center

AAU Coach's Name

AAU Coach's Email

AAU Coach's Phone

Scoring Average

Rebounding Average

Shooting Percentage

Free Throw Percentage

Assist Average

Honors/Awards

Other Sports Played

Eureka Student(s) or Alumni You Know

* required field