Questionnaire

 

                 Bing Xu, Head Volleyball Coach   Email: bxu@emporia.edu   Website: http://www.empoira.edu

         1200 Commercial Street  Box 4020 Emporia, KS 66801   Phone: (620) 341-6085; Fax: (620) 341-5603  

 

 

 

Personal Information:                                                                Athletic Information:

 

                                                                                                                                                                         

                                                                                                                                                                          Right       Left         

Last, First, Middle Name                                                                         Height     Weight                     Dominant Hand

 

                                                                                                                       Middle       Left       Right        Setter    

Social Security Number                                                                           Position (s)

 

                                                                                                                       Full Rotation          Front Row     Back Row     

Date of Birth (MM/DD/YY)                                                                  Rotation Play

 

                                                                                                                                                                          Yes          No           

Email Address                                                                                            Vertical Jump: inches           Are VB Films Available?

 

                                                                                                                       Volleyball Coach’s Information

Address: Box/Street                                                     Apt.                    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

                                                                                                                                                                                                                              

City                                            State                         Zip                            High School Jersey #

 

(                     )                                                                                                                                                                                                    

Telephone Number                                                                                   High School Coach               Phone Number

 

                                                                                                                                                                                                                            

Parents’ Name (s)                                                                                     High School Coach Email Address

 

                                                                                                                                                                                                                            

Occupation - - Father/Guardian                                                            Club Team Name

 

                                                                                                                                                                                                                            

Occupation - - Mother/Guardian                                                           Club Jersey #                          Years with Club Team

 

Academic Information:                                                                                                                                                       

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>                   Club Team Coach                 Phone Number

 

                                                                                                                                                                                                                            

Current School                                                                                           Club Team Coach Email Address

 

                                                                                                     

Type of  School (High School, JUCO, 4 - Years)

 

                                                                                                     

Graduation Date (MM/DD/YY)                          GPA

 

                                                                                                     

Area (s) of Academic Interest (s)

 

                                                                                                     

ACT/SAT Scores                                    Date Taken