Name:
First
 Last
 SS#
 Date of Birth
Address:
Street


City State Zip
Phone Email:
Father's Name: Occupation:
Mother's Name: Occupation:
Brothers & Sisters (ages) 
High School: Address: Phone:
Year of High School Graduation: 
High School Coach:  Phone:
Principal: Counselor: Phone:
Position Played:  Scoring Ave:
Rebounding Ave:  Assist Ave: #
Ht:
 
Wt:
 Recognition Achieved in Basketball:
 
Do you have a definite area of study that you are going to pursue in college?  Yes  No
If yes, please indicate
Have you taken the ACT test? Yes  No  If yes, please list your scores. 
English   Math   Science Reasoning   Reading Composite
If no, when are you planning to take it?
What is your approximate GPA?   Class Rank? /
Have you filed financial aid forms (FFS, FAF)?  Yes  No
Would you like more information concerning South Dakota Tech academics and basketball?
Yes  No
Do you know anyone who is attending or has attended SDSM&T? Yes  No
Additional information: