Blue & Gold Dance Team Questionnaire
 NOTE:This form is not an official college application.
This form will be used by the Dance Team 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  Gender (m/f) 

*Street Address 

*City  , *State  *Zip 

*Date of Birth (mo/day/yr) *Date of Grad (mo/yr) 

*Height (ft/in)  *Weight (lbs)

Ethnic Background (optional) 

Non-Athletic Activities
Student Body Officer
Editor, School Publication
*Field of Study
Class President National Honor Society Other 
Academic Information
*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
*Years of dance experience Dance Activities Varsity Letters *Coach's Name / Tel #
  Honors Other Sports  
   

Which of these can you perform?
Dbl-Triple Pirouette Fouettes Axle Splits Toe Touch Switch Split Leap

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