Personal Information

Name:

Address:

City:

State:

Zip Code:

Phone:

E-mail (required):

Height:

Weight:

Birth Date:

Sex:

Female Male

Parents' Name:

Occupation:

Academic Information

High School:

City:

State:

H.S. Counselor:

Graduation Year:

GPA:

ACT score:

SAT (M) Score:

SAT (V) Score:

Class Rank:

Academic Interest:

Swimming Information

High School Coach:

Phone:

Club Coach:

Phone:

Club Name:

Club Address:

Honors/ Awards, etc.:

In the following box please list the events you swim and your best time for that event.  Divers: please write lists d/d (1m & 3m).