Falcon Prospective Athlete Questionnaire Form

Prospective Student-Athlete Request for Information Form

If you are interested in Men's Basketball at UW-River Falls
and would like additional information, please fill out and submit the form below to Coach Jeff Berkhof.

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Last Name:		First Name:
Street1:
Street2:
City:		State:
Zip Code:
Area Code and Phone #:		Cell Phone #:
Your Email Address:
Birth Date (mm/dd/yyyy):
Parent(s) Name(s):
Parent(s) Occupations:

High School:		Graduation Year:
Coach's Name:
Coach's Phone:
Coach's E-mail:
Position:
Most Recent Level of Play:
Height:		Weight:
Grade Point Average:		ACT Score:
Academic Interest:
What Semester Do You Want to Begin?:
If You're a Transfer, From What School?:

Interest in UW-River Falls?:
Have You Applied to UW-River Falls?:
Have You Been Accepted to UW-River Falls?:
Athletic Honors, Awards, Stats:

If you have specific questions or additional requests, please use the box below.

For more information, write:
Jeff Berkhof
Men's Basketball Coach
Athletic Department
Hagestad Hall
410 S. Third St.
River Falls, WI 54022
or call
715/425-3726