PERSONAL INFORMATION

NAME:_______________________  NICKNAME:__________________________

DATE OF BIRTH____/____/_____ SOCIAL SECURITY #: _____- ____ -______

ADDRESS:__________________________________________________________

CITY:________________________ STATE:___________ ZIP:________________

PHONE: _____________________ EMAIL:_______________________________

MOTHER’S NAME:____________ OCCUPATION: _______________________

FATHER’S NAME: _____________OCCUPATION: _______________________

SIBLINGS/AGE______________________________________________________

ACADEMIC INFORMATION

HIGH SCHOOL:________________________________ GRAD DATE:________

ADDRESS:__________________________________________________________

CITY:________________________ STATE:___________ ZIP:________________

GUIDANCE COUNSELOR:________________________PHONE:____________

ATHLETIC DIRECTOR:__________________________ PHONE:____________

GPA:________________ CLASS RANK:______/_______ SAT’S:______________

HAVE YOU APPLIED TO WCSU?_________ DATE APPLIED:_____________

INTENDED AREA OF STUDY:________________________________________

SWIMMING INFORMATION

HEIGHT:____________ WEIGHT:___________ STROKE:_________________

HIGH SCHOOL COACH:_________________________ PHONE:____________

CLUB TEAM:________________________________________________________

CLUB COACH:__________________________________ PHONE:____________

NUMBER OF WORKOUTS/WEEK:____________________________________

AVG. DAILY YARDAGE:__________ AVG. WEEKLY YARDAGE:___________

DO YOU PARTICIPATE IN DRYLAND OR WEIGHT TRAINING?_________

HOW OFTEN?___________________ WHAT TYPE?______________________

OTHER INFORMATION

PLEASE LIST ANY HONORS (ACADEMIC, ATHLETIC, ETC)____________________
___________________________________________________________________
 

WHAT OTHER SCHOOL ARE YOU CONSIDERING?____________________

____________________________________________________________________

PERFORMANCE INFORMATION

PLEASE LIST BEST TIMES FOR HIGH SCHOOL/CLUB SWIM (YD/MTR)

SOPHMORE YEAR

JUNIOR YEAR

DIVING

BEST SCORE 1 METER:  6 DIVES:____________  11 DIVES ________________

BEST SCORE 3 METER: 6 DIVES_____________ 10 DIVES_________________