Southwestern Community College 
Basketball Questionnaire
Contact Mike Holmes   -  Cell Phone:  641-814-2010  or  Email: holmes@swcciowa.edu
 
  Personal Information
Name: Street Address: 
City:  State:   Zip: 
E-mail Address: 
Date of Birth: 

Names of Parents or Guardians 
Occupations: 
Home Phone: 
 
  

  Academic & Athletic Information
High School:    Graduation Year: 
Junior College: 
School Phone: 
To what other colleges will you apply? 
What is the likelihood of applying to Southwestern? 
What do you want to study in college? 

High school or college basketball coach's name: 
Position played:    Best or preferred position :
Height: 
Right or Left handed: 
Varisty basketball letters:   9    10   11   12
Team record last year: 

Last year's stats:    
Points/game 
Total points/game 
 FG% 
Rebounds/game 
Blocks/game 
3 Pt.% 
Assists/game 
Game High 
FT% 

 Captain: Yes No

Other sports in which you played: 
Awards or honors won: 
Grade point average: 
ACT score: 
Class ranking: 
PSAT score math and verbal: 
SAT score math and verbal: 
Academic Honors: 
Academic Interest: 
Level of interest in playing college basketball: Unquestionable Strong Maybe
Do you plan to play another college sport?  If so, what?  

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