Name:    Year of HS Graduation: 

Date of Birth:           Male              Female   

E-mail Address: 

Address: 

City:  State:  Zip: 

Home Phone:      Cell Phone:

Mother's Name:     Occupation:

Father's Name:      Occupation:

High School: 

HS Coach:   

HS Coach's Contact Phone: 

Name of Swim Club:

Club Coach: 

Club Coach Contact Phone: 

Height:  Weight:     

Rank in Class:       HS GPA: 

SAT (V):    SAT (M):    ACT:     

Top College Choices:

Desired College Major:

Best Times in Yards

Freestyle
50   100 200 500 1000 1650

Backstroke
50  100  200

Breaststroke
50  100  200

Butterfly
50  100  200

IM
200   400  


Best Diving Score

1 Meter (6 dives)   1 Meter (11 dives) 

3 Meter (6 dives)   3 Meter (11 dives) 


Years of participation:

Have you applied to Behrend?    Yes           No  

Do you plan to apply?  Yes         No  

Are you a transfer?   Yes         No  


Additional Information (other sports/activities)