For Prospective Western Connecticut Women's Basketball Student-Athletes

Tell us about yourself. This information will be forwarded to Head Coach Kimberley Rybczyk and give her notice that you are interested in playing at Western Connecticut State University.

GENERAL INFORMATION  
First Name:  
Last Name:  
Preferred Name:  
Street Address:  
City:  
State:  
Zip Code:  
     
Mobile Number:  
Email Address:  
Current High School:  
Year of Graduation:  
Date of Birth (mm/dd/yyyy):  
Facebook (paste the URL from your Facebook profile):  
Twitter (enter username only):  
Instagram (enter username only):  
     
     
FAMILY INFORMATION  
Father's First Name:  
Father's Last Name:  
Father's Occupation:  
Father's Employer:  
Fathers College:  
     
Mother's First Name:  
Mother's Last Name:  
Mother's Occupation:  
Mother's Employer:  
Mother's College:  
     
With whom do you live?:  
     
Name(s) of Siblings:  
     
Siblings Age(s):  
     
College Siblings attended (if any):  
     
ACADEMIC INFORMATION:  
     
Next Scheduled SAT Test Date:  
SAT Math:  
SAT Reading:  
SAT Writing:  
GPA:  
Class Rank ( ____ out of ___ ):  
Anticipated College Major:  
     
ATHLETIC INFORMATION:  
High School Coach:  
HS Coach Phone Number:  
HS Coach Email:  
HS Jersey Number:  
Height:  
Position:  
Points Per Game:  
3-Point Percentage:  
Rebounds Per Game:  
Injuries:  
     
AAU Team:  
AAU Coach:  
AAU Coach Contact Info:  
     
OTHER:  
     
Do you know anyone at WCSU?:  
Do you know any alumni from WCSU?:  
One interesting thing about you:  
     
Your top 3 priorities in your college search:  
     
Most influential person in your life:  
     
Name your top 5 schools in order of importance:  
     
Other sports played in HS?:  
     
Interested in playing which sport(s) in college:  
     
Injuries: