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Questionnaire for Prospective Volleyball Players

Personal Information
Full Name:
Home Address:
City:
State:
Zip Code:
Home Phone:
Fax:
Email Address
Birth Date:mm/dd/yyyy
Year of HS Graduation:

Parent / Guardian Information
Father's Name:
Father's Occupation:
Mother's Name:
Mother's Occupation:

High School Information
High School:
High School Address:
HS Graduation Date:
HS Grade Point Average:
Class Ranking (rank/class size):	out of

Standized Test Scores
PSAT:	Verbal:	Math:
SAT:	Verbal:	Math:
ACT:	Composite:
Academic Honors:

Athletic Information
Position:
Dominat Hand:
High School
HS Coach's Name:
HS Coach's Home Phone:
HS Coach's Work Phone:
HS Coach's email address:
HS Jersey # :
Club
Club Name
Club Coach's Name:
Club Coach's Home Phone:
Club Coach's Work Phone:
Club Coach's email address:
Club Jersey # :
Height:
Weight:
Standing Reach:
Vertical Jump without Approach (Block jump):
Vertical Jump with Approach (2 foot takeoff):
Vertical Jump with Approach (1 foot takeoff):
Bench Press (1 Max Rep):
Squat (1 Max Rep):
Have you suffered any serious injuries? If so, please list:
Have you ever had any surgeries? If so, please list:

Mt. Hood Community College

Potential Area of Study:

List your top 3 college choices:

How interested are you in attending Mt. Hood Community College?

Very Interested It Has Potential Safety School Need More Info

If you have a video tape available (including demonstration of skills as well as a complete unedited game) and if you have a high school and club volleyball schedule, please send it to the address below.

Contact Information

Head Coach: Lena Chan
Office Phone: (503)491-7453
Fax: (503) 491-7397
Email Address: chanl@mhcc.edu
Web Site: www.mhcc.edu

PLEASE EITHER PRINT AND SEND THE COMPLETED QUESTIONAIRE TO :
Mt. Hood CC Volleyball
26000 SE Stark St
Gresham Oregon 97030

CLICK THE SUBMIT BUTTON and it will be sent directly to Coach Chan's Email