Elite Basketball Player Nomination Form

Player Full Name
Gender Boys    Girls
Position Point Guard       Guard   Post
Grade Next Year - 2010 9th       10th   11th    12th
Height & Weight &
High School
High School Coach 
High School Coach Email Address
AAU Team
AAU Coach 
   

Do you play other Sports (if so explain)
   

Uniform Information

Shorts Size

 Med   Large  1X    2X  3X 4X
Jersey Size Med   Large  1X    2X  3X 4X
   

Academic Information
GPA
ACT Score
SAT Score
Are you in NCAA Clearinghouse?
What are you considering your major course of study in college?
   

Parent or Legal Guardian Registration Contact Information - Confidential
Parent Full Name (Required)
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Primary Phone #1 Cell Home Office
Alternative Phone #2 Cell Home Office
Fax
 E-mail (Required)

Confidential Medical Information

Any allergies or medical condition

 No    Yes (Explain below)
If yes explain
Athlete's Physician 
Address
Phone Number
Medical Insurance Company Name
Policy #
Medical Insurance Phone #
   

Why should we consider the nominated player? 

Comments and Accomplishments (Academic and Athletic)

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