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EAST CAROLINA SWIMMING & DIVING QUESTIONNAIRRE

PERSONAL INFORMATION

Full Name:
Gender:
Height:
Weight:
DOB:
Year in School:
NCAA Registration #:

CONTACT INFORMATION

Home Address:
City, State:
Zip Code:
Home Phone:
Cell:
E-Mail Address(s):
Best Time To Contact:

FAMILY INFORMATION

Fathers Name:
College Attended:
Occupation/ Position:
Mothers Name:
College Attended:
Occupation/Position:
Siblings, Ages:

HIGH SCHOOL INFORMATION

Date of Graduation:
H.S. & Address:
Current GPA:
SAT:
ACT:
Math:
Verbal:
Essay:

SWIMMING INFORMATION

Club:
Coach:
Coach's Phone:
Coach's Email:
Number of Workouts Per Week:
Average Workout Yardage:
Number of Dryland/Weights:
Ever Have Any Injuries, When?:
What Do You Bring To The Team?:

EVENT INFORMATION

Event Best Time Year Achieved
50FR
100-Free
200-Free
500-Free
1000-Free
1650-Free
100-Butterfly
200-Butterfly
100-Backstroke
200-Backstroke
100-Breaststroke
200-Breaststroke
200-IM
400-IM
1-Meter Dive
3-Meter Dive
Platform

   

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