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OREDIGGER WOMENS BASKETBALL
PROSPECT QUESTIONNAIRE

First Name

Last Name

Date

Age

Height

Weight

Birthdate

ADDRESS INFORMATION

Parent's or Permanent Address:

Phone:

Street		City
State		Zip

SCHOOL INFORMATION

GPA

ACT score

SAT score

Class Rank

Anticipated College Major:

High School Name

Year of Graduation

Street		City
State		Zip

Guidance Counselor		School Phone
Coach's Name		Office Number

Home Phone

BASKETBALL STATS

Points Per Game

FG%

FT%

Rebounds

Assists

Vertical Jump

Athletic Injuries:

Honors (Academic/Athletic)

Any Questions Contact Brian Holsinger:
Montana Tech
Womens Basketball
1300 West Park Street
Butte, MT 59701
(406) 496-4766

Questions and Comments:
1-800-445-TECH • 406-496-4178 • Email Us!