For Prospective Western Connecticut Women's Basketball Student-Athletes

Tell us about yourself. This information will be forwarded to Head Coach Kimberley Rybczyk and give her notice that you are interested in playing at Western Connecticut State University.

Personal Information  
First Name:  
Last Name:  
Preferred Name:  
Street Address:  
Zip Code:  
Mobile Number:  
Email Address:  
Google Talk:  
Facebook (paste the URL from your Facebook profile):  
Twitter (enter username only):  
Instagram (enter username only):  
What is your connection to the university:  
Parent's Information  
Father's First Name:  
Father's Last Name:  
Father's Occupation:  
Father's Employer:  
Fathers College:  
Mother's First Name:  
Mother's Last Name:  
Mother's Occupation:  
Mother's Employer:  
Mother's College:  
With whom do you live?:  
Name(s) of Siblings:  
Siblings Age(s):  
College Siblings attended (if any):  
Current High School:  
Year of Graduation:  
Date of Birth (mm/dd/yyyy):  
Guidance Counselor:  
SAT Test Date:  
SAT Math:  
SAT Reading:  
SAT Writing:  
Class Rank ( ____ out of ___ ):  
Anticipated College Major:  
Athletic Information:  
High School Coach:  
HS Coach Phone Number:  
HS Coach Email:  
HS Jersey Number:  
Points Per Game:  
AAU Team:  
AAU Coach:  
AAU Coach Contact Info:  
One interesting thing about you:  
Your top 3 priorities in your college search:  
Most influential person in your life:  
Name your top 5 schools in order of importance:  
Other sports played in HS?:  
Interested in playing which sport(s) in college: