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Swimming
Prospective Student Questionnaire

Prospective Student Questionnaire: Swimming

General

Name: *

Home Address: *

City: *

State: *

Zip: *

Email: *

Home Phone: *

Cell Phone:

Parent's/Guardian's Name:

Swimming Information

Club Name:

Club Coach's Name:

Club Coach's Phone:

High School Swim Team:

High School Coach's Name:

High School Coach's Phone:

How long have you been swimming?: *

List other sports::

What are your major considerations when choosing a college?: *

Academic match

Amount of scholarship offered

Quality of lacrosse program

Location of school

Getting along with the team

Getting along with the coach

When do you plan to commit?: *

Fall

Spring

List your best times and in what event (short course yards/long course meters):

List 3 of your athletic strengths:

List 3 of your athletic weaknesses:

Approximate Yardage/Practice (midseason):

Kicking yardage:

Pulling yardage:

Swimming yardage:

Number of practices/week:

Favorite sets:

High School Information

School Name:

Location of School:

Expected Graduation Date:

Medical Information

Have you had any type of surgery?:

Yes

No

If yes, please list:

Have you ever, or do you now take medication for asthma?:

Yes

No

If so, please list the medication:

Are you currently taking ANY type of medication?:

Yes

No

Please list all medications:

Qualifications

Have you qualified for state?: *

Yes

No

Have you qualified for Y Nationals?: *

Yes

No

Have you qualified for Jr. Nationals?: *

Yes

No

If yes:

A Cut

B Cut

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