Name
First:	Last:
Address
Street:
City:	State: Zip:
Home Phone:	Cell Phone:
Email:
High School:
High School Coach:		Phone:
Position Played: Scoring Ave: Rebounding Ave.
Assist Ave: Ht:
Basketball Honors: (All-Conference, All-State, etc.)
Graduation Date:	Academic Major:
Have you taken the ACT test? Yes No      If yes, please list your score:
If no, when are you planning on taking it?
What is your approximate GPA:    Class Rank:
Would you like more information concerning Dakota State Lady T's basketball and academics?  Yes No
Do you know anyone who is attending DSU? Yes No
Who?