Name:

Date of Birth:

Address:

City, State:

Zip Code:

Phone Number:

Graduation Date:

Height:

Weight:

E-mail Address:

Mother's Name:

Mother's Occupation/Work Phone:

Father's Name:

Father's Occupation/Work Phone:

High School:

School Phone:

School Address:

City, State:

Zip:

H.S. Coaches Name:

Home Phone:

Guudance Counselor:

Counselor Phone:

GPA:

Approx. Class Rank:

ACT Score:

SAT Score:

Academic Interest 1:

Academic Interest 2:

Other Activities:

Are you registered with the NCAA Clearinghouse?

Position:

AAU Team:

AAU Coach:

AAU Coach's Phone Number:

Level of Interest in Lake Land College(high, moderate, low):

Individual and Team Honors/Awards:

Pertinent Individual Statistics (i.e., points, rebounds, assists, etc.):

For more information on Lake Land College, you can check the Lake Land College Women's Basketball web page at: www.lakeland.cc.il.us/athletics/wbasketball or email the coach at:

Coach David Johnson: djohnson@lakeland.cc.il.us

Thank you for your interest in Lake Land College!!
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