Thank you for your time in providing information for this form. Please note, this form does NOT serve as an application for the college. This form is to provide Northeast Mississippi Community College coaches with the necessary information about yourself. For an application to the college, please visit the NEMCC Homepage at http://www.nemcc.edu

NOTE: All form boxes that are outlined in red are REQUIRED fields and the form cannot be submitted without filling out those forms. 
 

Please remember to confirm your form once you hit the submit key, hitting the submit key only saves your answers until you confirm your form. If successful, you should receive a confirmation page of the form being submitted.




PERSONAL INFORMATION      
       
Name Birth Date (mm/dd/yy)
Height Weight
Address Home Phone
City Cell Phone
State Email
Zip Code

       
GUARDIAN INFORMATION      
       
Mother or Legal Guardian Father or Legal Guardian
Occupation Occupation
Address Address
City City
State State
Zip Code Zip Code
Home Phone Home Phone
Cell Phone Cell Phone
Email Email
       
HIGH SCHOOL INFORMATION      
       
School Graduation Date
Address Grade Point Average (GPA)
City ACT Score
State Class Rank
Zip Code Honors 
Phone Clubs
       
HIGH SCHOOL ATHLETIC INFORMATION      
       
Coach Other Sports Played
Phone Awards (List all sports)
Email Achievements (List all sports)
       
HIGH SCHOOL STATS      
       
Points Per Game Posistion(s)
Rebounds Per Game 2-Point FG Percentage
Assists Per Game 3-Point FG Percentage
Steals Per Game Free Throw Percentage
Blocks Per Game Video Available?
       
AAU TEAM INFORMATION      
       
Coach Team Name
Phone Awards
Email Achievements
       
AAU STATS      
       
Points Per Game Posisition(s)
Rebounds Per Game 2-Point FG Percentage
Assists Per Game 3-Point FG Percentage
Steals Per Game Free Throw Percentage
Blocks Per Game Video Available?
       
TRANSFER STUDENTS      
       
College Year in College
Address Grade Point Average (GPA)
City Major
State Reason(s) for Transfer
Zip Code Other Sport(s) Played
       
COLLEGE BASKETBALL STATS      
       
Points Per Game Posistion(s)
Rebounds Per Game 2-Point FG Percentage
Assists Per Game 3-Point FG Percentage
Steals Per Game Free Throw Percentage
Blocks Per Game Video Available?