JCPA Questionnaire

JCPA Questionnaire
Contact Information
Your Name*

First NameLast Name
INTEREST*

PGJUCO
Date of Birth*
Graduation Year*
Main Sport*
Primary Position*
Height *
Weight*
40 Yard Dash*
High School/College*
City*
State*
Are you registered at NCAA Eligibility Center? If not, please register at www.web3.ncaa.org*

YesNo
NCAA Certification #*
N/A if not registered
NCAA CERTIFICATION STATUS*

FULL QUALIFIERPARTIAL QUALIFIERNON-QUALIFIERUNKNOWN
CORE GPA*
OVERALL GPA*
Intended Major*
School Information
D1, D2, NAIA Schools That Offered YOU*
D1, D2, NAIA Schools that are Interested in YOU*
Name 5 schools where you would like to play at*
Your E-mail*
Your Twitter*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
Evening Phone*

Area CodePhone Number
Father/Guardian Name*
Mother/Guardian Name*
Father/Guardian Cell Phone *
Mother/Guardian Cell*
Father/Guardian Email*
Mother/Guardian Email*
Coach's Information
Coach's Name*
Coach's Contact Number*
Coach's Email*
Football
Primary Football Position(s)

QBWRRBFBTEOLDBLBDLCBSSDTDEKPLong Snapper
Secondary Football Position(s)

QBWRRBFBTEOLDBLBDLCBSSDTDEKPLong Snapper
Track
Primary Track Position(s)

10020040080016003200110 Hurdles440 HurdlesJavelinShot PutDiscusPole Vault4X1004X2004X400SprintMedleyLong MedleyMarathon
Secondary Track Position(s)

10020040080016003200110 Hurdles440 HurdlesJavelinShot PutDiscusPole Vault4X1004X2004X400SprintMedleyLong MedleyMarathon
Wrestling
Wrestling Primary

125133141149157165174184197285
Wrestling Secondary

125133141149157165174184197285
Mens Basketball
Primary Basketball Position(s)

PGSGSFPFC
Secondary Basketball Position(s)

PGSGSFPFC
Ice Hockey
Primary Ice Hockey Position(s)

CLWRWGLDRD
Secondary Ice Hockey Position(s)

CLWRWGLDRD
Academic History
Did you take SAT? If not, when?*

YESNOOther
Did you take ACT? If not, when?*

YESNOOther
SAT Math*
SAT Verbal*
SAT Writing*
SAT Total*
ACT Score*
Additional Information/Comments/Questions
Highlight Link*
Athletic Honors
Other Varsity Sports Played and Accolades
Most Noteworthy Stat*
Comments/ Questions
What JCPA representative recruited you?*
Should be Empty:

JCPA Questionnaire

Contact Information

School Information

Coach's Information

Football

Track

Wrestling

Mens Basketball

Ice Hockey

Academic History

Additional Information/Comments/Questions