Swimming & Diving - Questionnaire

Swimming & Diving Questionnaire

Name:

Street Address:

City/Town:

Zip:

Home Phone:

Cell Phone:

E-Mail Address:

Date of Birth:

Social Security #:

Height:

Weight:

Father's Name:

Occupation:

Mother's Name:

Occupation:

Brother's Name(s):

Sister's Name(s):

High School:

Year of Graduation:

School Address:

SAT Scores:

V M W

ACT Score:

GPA:

Intended Major(s):

Have you registered with the NCAA Clearinghouse through your guidance office? Yes No
If you have registered, when?
Did you list Northeastern as one of the schools allowed access to your file? Yes No
If no, please see your guidance counselor immediately.

Years Swimming:

Club: High School:

High School Coach:

Phone Number:

Club Team:

Club Address:

Club Coach:

Phone Number:

Swimming Times & Events

Free	Back	Fly
50	100	100
100	200	200
200
500	Breast	IM
1000	100	200
1650	200	400

Diving Information

US Diving Team:

Coach:

Optionals:
1 Meter	3 Meter



High Scores:
1 Meter - 6 Dives	3 Meter - 6 Dives

1 Meter - 11 Dives	3 Meter - 11 Dives

Enter any other questions or comments in the space below:

If you need to contact the swimming office directly, call (617) 373-2676 or e-mail swimming@GoNU.com.