Bethany Swede Women's Basketball
Prospective Student-Athlete Information Form

NOTE:This form is not an official college application.
This form will be used by the basketball staff to help determine prospective student-athletes.
Items marked with an astrisk* 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 (Indicate 1st Choice)
Trainer Volleyball Basketball Dance/Cheer Golf Soccer Tennis Track/CC
                    (Indicate 2nd Choice)
Trainer Volleyball Basketball Dance/Cheer Golf Soccer Tennis Track/CC

Non-Athletic Activities
Student Body Officer
Editor, School Publication
*Field of Study
Class President National Honor Society 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: January 8, 2007