Swimming & Diving Questionnaire

Personal Information
Name
 Graduation Year

Preferred First Name
 Sex
Male      Female		 Date of Birth

Address

City
 State
 Zip

Email Address

Home Phone
 Cell Phone

Preferred method(s) of communication from Coaching Staff
phone      email      text

Father's Name
 Occupation

Mother's Name
 Occupation


Swimming and Diving Information

Best Times in Yards

Freestyle
      50       100       200       500       1000       1650

Backstroke
      50       100       200

Breaststroke
      50       100       200

Butterfly
      50       100       200

IM
      200       400

Diving - Best Score (please list dives below)
1m(6) (11)
3m(6) (11)

Dives

Names of Coach(es)

High School
 Phone

Club
 Phone


Academic Information

High School

Planned College Major
 Cumulative GPA

SAT Score (CR)
 SAT Score (M)

ACT Score

List other high school activities/sports in which you participate