College Men's Basketball
Prospective Student-Athlete Information Form
NOTE:This form is not an official college application.
This form will be used by the Athletic personnel for recruitment purposes.
Items marked with an asterisk* are required.

Personal Information

*Last Name *First Name  Middle I. 
*Home Phone # *E-mail Address
Country 
*Street Address 
*City  , *State  *Zip 
*Date of Birth (mo/day/yr) *Date of Grad (mo/yr) 
*Height (ft/in)  *Weight (lbs)
Ethnic Background (optional) 

Preference of College Participation 1st Choice
Trainer Baseball Basketball Football Golf Soccer Tennis Track/CC

Preference of College Participation 2nd Choice 
Trainer Baseball Basketball Football Golf Soccer Tennis Track/CC
Non-Athletic Activities
Student Body Officer
Editor, School Publication
Class President National Honor Society
*Field of Study Other 
Academic Information
Academic Interest Areas 1) 2) 3)

*Class Rank  *out of  *G.P.A. 

Test Scores:

SAT: Date (mo/day/yr)  Verbal  Math 
ACT: Date (mo/day/yr)  Composite   

*High School Name  *Year in School (fr/so/ju/sr) 
*Address 
*City  , *State  *Zip  *Phone 
Guidance Counselor 

Athletic Background
Average PPG Assists Blocks *Coach's Name / Tel #
Rebounds Steals Team Record Other Sports
Field Goal % Free Throw % Vars. Letter Honors
Three Point % Charges Taken Academic Goals *College Basketball Goals

Team Accomplishments

Interest Level
Please select the level that represents your present interest in Bethany.
Other Colleges of Interest 
Do you intend to apply for financial assistance to attend college (optional).  Yes  No


Bethany College
335 E. Swensson Street
Lindsborg, Kansas 67456-1897

Telephone: 1-785-227-3311 or 3380 x 8113
Admissions Fax: 1-785-227-8993
Admissions Telephone: 1-800-826-2281

 Copyright © 2006 Bethany College
Last Modified: March 13, 2007