Prospective Student-Athlete

Swimming & Diving Questionnaire

PERSONAL BACKGROUND

First Name: Last Name:
Name you go by: Email Address:
Area Code: Phone Number:
Street Address: City:
State: Zip:
Date of Birth (Month/Day/Year): Social Security #:
Height: Weight:
Father's Name: Mother's Name:
Father's Occupation: Mother's Occupation:
Does either of your parents work at Washington University? Yes No
College Attended: College Attended:
Living with MotherFatherBothOther

ACADEMIC BACKGROUND (Please list Washington U. as one of the schools to receive your test scores.)

High School High School City:
High School State: High School Zip:
Coach's Name and Email Address: Home Phone:
Counselor's Name and Email Address: School Number:
GPA: /4.0 Class Rank: / SAT-CR: SAT-M: SAT-W:
ACT Composite: Math: English: Reading: Science: Writing:
Date of Graduation:  
Senior Class Schedule:
Academic Honors:
Academic Interests:

1)

2) 3)
Other Colleges You are Interested In:

1)

2) 3)

ATHLETIC BACKGROUND

FREE: BREAST: FLY:
DIST: TIME: YEAR: DIST: TIME: YEAR: DIST: TIME: YEAR:
50 yd: 100 yd: 100 yd:
100 yd: 200 yd: 200 yd:
200 yd: BACK: IM:
500 yd: 100 yd: 200 yd:
1000 yd: 200 yd: 400 yd:
1650 yd:
DIVING:
(1M) 6 Dives (1M) 11 Dives
(3M) 6 Dives (3M) 11 Dives
Athletic Honors:
Club Team:
Coach of Club Team:
Club Coach Phone Number:
Coach of HS Team:
HS Coach Phone Number:
List Other Varsity Sports Played: