Wentworth Institute of Technology

Prospective Student Athlete Questionnaire

Dear prospective student-athlete:

Please take a moment to fill out this questionnaire if you are interested in Wentworth Athletics. Please be advised the NCAA regulations prohibit any member of an institution's coaching staff from contacting you prior to July 1 before your senior year in high school. Your completed questionnaire will be forward to the head coach of the sport or sports you have indicated.

Thank you for your interest in Wentworth Athletics!!

The Wentworth Athletic Department

Personal Information

Full Name:

Date of Birth:

Street Address:

City:

State: Zip:

Home Phone:

Email:

Parents' Information

Father's Name:

Father's Occupation:

Home Phone:

Work Phone:

Mother's Name:

Mother's Occupation:

Home Phone:

Work Phone:

Academic Information

High School:

Guidance Counselor:

Street Address:

City:

State: Zip:

Class Rank:

out of Grade Point Average:

Test Scores:

SATs: Verbal: Math: Total:

ACT Score:

Academic Honors:

Year of Graduation:

Athletic Information

Athletic Honors:

Sports:

Sport (1)	Sport (2)

Position:	Position:
Stats:	Stats:
Coach's Name:	Coach's Name:
Phone #:	Phone #:
Game Tapes Available: Yes: No:	Game Tapes Available: Yes: No:

Additional Information

How did you hear about Wentworth?:

Intended Major:

Academic Interests:

Other Colleges Considering:

Is Wentworth one of your final five colleges? Yes: No:

Tell us something about yourself: