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Personal Information
Name:
Prefer to be called:
E-mail Address:
Address:
City:
State:
Zip code:
Phone:
DOB:
Age:
SSN:
Height:
Weight:
Mother's Name:
Occupation:
Father's Name:
Occupation:

Academic Information
High School:
Graduation Date:
School Address:
City:
State:
Zip code:
School Phone:
Guidance Counselor:
SAT Score:V M W
SAT Test Date:
ACT Score:
ACT Test Date:
GPA:
Class Rank:
Potential Major:

Athletic Information
US Swimming, US Diving, or AAU team:
Coach's Name:
Coach's Phone Number:
Coach's E-mail:
Address:
City:
State:
Zip Code:
High School Coach:
High School Coach's Phone Number
High School Coach's E-mail:
Have you registered with NCAA Clearinghouse?:Yes. No.    NCAA #

List of Best Scores and Dives

1-meter Optional Dives [Ex. 105B] : Dives:

6 Dive Score:Scores: Date:
11 Dive Score (if number of dives is different, note after):Scores: Date:

3-meter Optional Dives [Ex. 105B] : Dives:

6 Dive Score:Scores: Date:
11 Dive Score (if number of dives is different, note after): Scores: Date:

List of Times

 ScoreDate
50 Free:
100 Free:
200 Free:
400/500 Free:
800/1000 Free:
1500/1650 Free:
200 IM:
100 Back:
200 Back:
100 Breast:
200 Breast:
100 Fly:
200 Fly:
400 IM:

Do you know anyone else attending ODU?:
What are the top three Universities you are interested in?:

What sparked your interest in ODU?:

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