Athletic Questionnaire - Cheerleading Squad

Becky Ziegler,
Cheerleading Coach
Email: bziegler@drury.edu

Last Name:
First Name:
Middle Name:
Gender: Male Female
Home Phone:
Cell Phone:
Address:
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State:
Zip:
SSN#
Date of Birth:
Email:
Parent Name:
Day Phone:
Parent Name:
Day Phone:
Occupation(s)
List any friends or relatives that have or are attending Drury.
Academic Information
High School:
Address:
Phone:
Graduation Year:
Intended Major(s):
GPA(4.0 scale):
Class Rank: /
ACT:
Date Taken(mm/dd/yy):
SAT:
Date Taken(mm/dd/yy):
TOEFL(Foreign students only):
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Academic Honors and Recognitions:
Athletic Information
Coach:
Coach's Phone:
Age:
Height:
Weight:
Number of years cheerleading:
Best Stunts:
Best tumbling pass:
Any Standing tumbling:
Best Jump :
Honors and Recognition:
Serious Injuries/Illnesses:
Other Sports:
Comments: