Women's Swimming Recruit Questionnaire

*Required fields.

Personal Information

Prospect Code: *
First Name: *		Last Name: *
Middle Name:		Preferred Name:
Email: *
Address: *		City: *
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Country:		Phone: *
Mobile/Alt. Phone:		Gender:
Place of Birth:		Date of Birth: *
Hobbies:
Parent/Guardian Contact Information
First Name: *		Last Name: *
Relationship: *		Home Phone: *
Mobile Phone:		Email:
College Attended:		Occupation:
Employer:		Work Phone:
Extension:
Parent/Guardian Contact Information
First Name: *		Last Name: *
Relationship: *		Home Phone: *
Mobile Phone:		Email:
College Attended:		Occupation:
Employer:		Work Phone:
Extension:
Academic Information
SAT:		SAT Math:
SAT Verbal:		ACT:
GPA: *		Class: *
Class Rank:		Grad Year: *
Registered with Clearinghouse: *	Yes No	Intended Major:
1st College Preference:		2nd College Preference:
3rd College Preference:
Athletic Information
NCAA Eligibility #:
Height: *		Weight: *
50yd Freestyle:		50m Freestyle:
100yd Freestyle:		100m Freestyle:
200yd Freestyle:		200m Freestyle:
500yd Freestyle:		400m Freestyle:
1000yd Freestyle:		800m Freestyle:
1650yd Freestyle:		1500m Freestyle:
100yd Butterfly:		100m Butterfly:
200yd Butterfly:		200m Butterfly:
100yd Backstroke:		100m Backstroke:
200yd Backstroke:		200m Backstroke:
100yd Breaststroke:		100m Breaststroke:
200yd Breaststroke:		200m Breaststroke:
200yd IM:		200m IM:
400yd IM:		400m IM:
School Information
School Name: *		Address 1: *
Address 2:		City: *
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Country:		Phone:
Fax:
School Coach Information
First Name: *		Last Name: *
Email:		Title: *
Work Phone:		Mobile Phone:
Home Phone: