Prospective Student-Athlete
Information Form

Today's Date:

Personal Information

Name: Date of Birth:
Home Address:
City: State:Zip Code:
Country: Telephone: E-Mail:
Best time to get a hold of you is: Weekdays Weekends
Social Security Number
Mother's NameWork Phone:
Father's Name: Work Phone:

Current School:Year of Graduation:
School Address:
City: State:Zip Code:
Telephone: FAX:
Guidance Counselor: Telephone:
Current GPA: Cumulative GPA:
PSAT: Verbal Math Total Score Next testing date
SAT: VerbalMath: Total ScoreNext testing date
ACT: English Math:Reading:ScienceNext testing date
TOFEL: EnglishMath: Total ScoreNext testing date

Current College:Graduation date:
AA degree: Major: Year Obtained: GPA:
Four-year College:
City: State:Zip Code:
Academic Advisor: Telephone:
Total Number of Credits: Current GPA: Overall GPA:

Academic Interests:
Other school you are interested in
List four criteria when choosing a school:
1.)
2.)
3.)
4.)

Club Name: Years of swimming:
Coach's Name: Telephone:
Coach's E-mail: Practice times: Mon-Fri Saturday
Number of swimming practices per week: Average yardage per week:
Dry-land workouts per week: Weight practices per week:

List your best six events: Specify if the times were obtained in SCY, SCM or LCM

exp:	Event 50 free	Time 22.82	Pool SCY	Meet JO's	Date of Swim 7/20/2002
1.
2.
3.
4.
5.
6.

Please mark the swim meets you have competed in (mark all that apply):
Olympic Games Would Championships Pan American Games Pan Pacs Goodwill Games
World Cups European Championships South American Games U.S. Olympic Trials
USA Senior Nationals US Open Your Country's Senior Nationals US Zone
Other:

Swimming Honors and Awards:

Diving Information

Club Name:
Club Coach's Name: Telephone:
Club Coach's E-mail:
High School Coach's Name: Telephone:
High School Coach's E-mail:
Diving Accomplishments:
Your 1m list:
Your 3m list:
Your platform list:

What meets will you compete in this year?(include dates):

Years of diving: Number of diviing practices per week:
Do you lift weights: Yes No | Do you do dry-land: Yes No

What are your strengths as a diver?:

What are your weaknesses as a diver?:

What are your athletic goals?: