USA High Performance Player Application-Men's

All players that are currently on the USA National or Junior National Teams and interested players are required to fill out the High Performance Player Application.  If you receive an error message that your email address is already in the system please contact Jeanine LaSage at or 719-266-4082.

 Before beginning, please be sure to have all information below:

Personal Contact Information:

Legal First Name, Last Name, Preferred Name

U.S. Mailing Address

Phone Number

Email Address 

Country of Citizenship

Teams you are affiliated with

Birth City, Birth State


Years playing wheelchair basketball

Highest level of education you have completed

Currently Employed? If yes, please list employer


List of Accomplishments (NWBA and International)

List of Academic Accomplishments

Local Newspaper

Local TV Station(s)


Functional Classification

Medical Classification

Sitting Height

Wing Span

Weight of Chair

Wheelchair Manufacturer



Date of Birth

Last Four of SSN

Do you have a passport?

If yes, what country was the passport issued in?

If yes, please provide passport number

If yes, please list name as it appears on passport

Please list name as it appears on drivers license

Closest Airport

Closest major airport if different that closest airport

Do you use an everyday wheelchair?

Do you need assistance transferring?

Emergency Contact Information

First name, last name


Phone Number

Email Address


Please list top three preferences for jersey numbers (Between #4-15)

Uni-Sex Sizes

  • Jersey Size
  • Short-Sleeved T-Shirt
  • Long-Sleeved T-Shirt
  • Hoodie
  • Sweatpant
Men's Sizes *Women will be required to fill out both men and women sizes. Although we do our best to accommodate our women's teams clothing preferences, please list men's sizes as well if we are unable to accommodate certain requests. Thank you for your understanding.*
  • Polo 
  • Sport Bra
  • Shoe Size (Adult, Youth)
  • Warm-Up Jacket
  • Warm-Up Pant
  • Long-Sleeved Dri-Fit
  • Short-Sleeved Dri-Fit
  • Long-Sleeved Loose-Fit
  • Short-Sleeved Loose-Fit
  • Shooting Shirt
  • Short
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