Please fill out the form below as completely as possible. The form does not need to be complete, however the required fields with an asterisk (*) must to be filled out.

General Information

First Name:

Last Name:

E-mail Address:

Street Address:

City, State, Zip:

Phone Number:

Mobile Phone Number:

High School:

Graduation Date:

Birth Date:

Social Security #:

Father's Name:

Father's Address:

Father's Phone#:

Father's Occupation:

Father's University:

Mother's Name:

Mother's Address:

Mother's Phone #:

Mother's Occupation:

Mother's University:

Counselor's Name:

Counselor's eMail:

Counselor Phone #:

Intended College Major:

SAT Critical Reading:

SAT Math:

SAT Writing:

SAT Subject Tests (min 2 required):

Class Rank:

ACT:

GPA:

Class Rank:

Other universities to which you are applying:

Stats

Height:

Weight:

Vertical Jump:

Shoe size:

Club Coach's Name:

Coach's eMail:

Coach's Phone Number

Times

50 Free

100 Free

200 Free

500 Free

1000 Free

1650 Free

100 Back

200 Back

100 Fly

200 Fly

100 Breast

200 Breast

200 IM

400 IM

Swimming and other athletic achievements, Comments: