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 firstname.lastname@example.org 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
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 TV Station(s)
Weight of Chair
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 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
Please list top three preferences for jersey numbers (Between #4-15)
- Jersey Size
- Short-Sleeved T-Shirt
- Long-Sleeved T-Shirt
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.*
- 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