PERSONAL
First Name_________________________ Last Name________________________
Address___________________________ City_____________ ST___ ZIP_______
Home Phone____________ Cell Phone____________ E-mail_________________
Father __________________ Occupation______________ College____________
Mother__________________ Occupation______________ College____________
Have you applied to Surry CC
Yes
No Date of Birth_____________
Will you be applying for financial aid?
Yes
No
ACADEMIC
High School_________________________________ Graduation Date__________
H.S. Address________________________ City_____________ ST___ ZIP______
Guidance Counselor____________________________ Phone_________________
SAT total_________ M_____ V_____ ACT_____ GPA______ Class Rank________
Desired College Major___________________ Career Plans__________________
VOLLEYBALL
Primary Position___________________ Secondary Position__________________
Height______ Volleyball Awards_____________________________
High School Coach____________________________ Phone #________________
Summer Coach_______________________________ Phone #________________
Colleges that have contacted you_______________________________
Other sports played________________________ Honors______________________
PLEASE RETURN QUESTIONNAIRE TO: Surry CC Attn: May Dobson 630 South Main Street Dobson, NC 27017