Prospective Swim and Dive Athlete Questionnaire

Email Secondary Email

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Email address *

First name *

Last name *

Address 1

City

State

ZIP Code

Cell Phone Number *

Date of Birth

Mother's name

Father's name

Parent/Guardian phone number

Year of high school graduation

High School

High School Coach

Events competed in

Please list all swimming and diving events that you have competed in

Personal Records

Please list all of your swimming and diving personal records

Other high school activities

Please list all high school activities that you participated in (other sports, clubs, etc.)

High School Athletic Honors

Please list all high school athletic honors received with years included (All-conference, state qualifier, etc.)

Additional Information

This is your opportunity to provide any additional information as to why you believe that you would be a good addition to the LSSU swimming and diving program.

* required field