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: Jan Marion-Kiser
630 South Main Street
Dobson, NC  27017