JCPA Questionnaire

JCPA Questionnaire
Contact Information
Your Name *

First Name Last Name
INTEREST *

PG JUCO
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 *

Yes No
NCAA Certification # *
N/A if not registered
NCAA CERTIFICATION STATUS *

FULL QUALIFIER PARTIAL QUALIFIER NON-QUALIFIER UNKNOWN
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 *

Home Address *

Cell Phone *

Area Code Phone Number
Evening Phone *

Area Code Phone 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)

QB WR RB FB TE OL DB LB DL CB SS DT DE K P Long Snapper
Secondary Football Position(s)

QB WR RB FB TE OL DB LB DL CB SS DT DE K P Long Snapper
Track
Primary Track Position(s)

100 200 400 800 1600 3200 110 Hurdles 440 Hurdles Javelin Shot Put Discus Pole Vault 4X100 4X200 4X400 Sprint Medley Long Medley Marathon
Secondary Track Position(s)

100 200 400 800 1600 3200 110 Hurdles 440 Hurdles Javelin Shot Put Discus Pole Vault 4X100 4X200 4X400 Sprint Medley Long Medley Marathon
Wrestling
Wrestling Primary

125 133 141 149 157 165 174 184 197 285
Wrestling Secondary

125 133 141 149 157 165 174 184 197 285
Mens Basketball
Primary Basketball Position(s)

PG SG SF PF C
Secondary Basketball Position(s)

PG SG SF PF C
Ice Hockey
Primary Ice Hockey Position(s)

C LW RW G LD RD
Secondary Ice Hockey Position(s)

C LW RW G LD RD
Academic History
Did you take SAT? If not, when? *

YES NO
Did you take ACT? If not, when? *

YES NO
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
Should be Empty: