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Navy Heavyweight Rowing Questionnaire

Date Completed:
Personal Information
Name:
Nickname:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Birthdate:
Birthplace:
Father's Name:
Father's Occupation:
Father's Phone Number:
Father's College:
Mother's Name:
Mother's Occupation:
Mother's Phone Number:
Mother's College:
I live with
(Mother,Father, Both, or Other):
Are you a U.S. Citizen?:
Do you wear glasses or contact lenses?:
Do you have asthma?:
Medications Taking:
Ethnic Background: 
White/Caucasian Black/African American Hispanic American Indian/Alaskan Native
Filipino Asian/Pacific Islander Other      

Academic Information
High School/Prep School:
Address:
City, State:
County:
Zip:
Phone:
Academic Interest:
G.P.A,On Scale of:
Class Rank-Class Size:
PSAT Score V: M: Date Taken:
SAT Score V: M: Date Taken:
ACT Score V: M: Date Taken:
Date of Graduation:

Rowing Information
Height:
Weight:
2000 Meter Erg Score:
6000 Meter Erg Score:
500 Meter Erg Score:
1-Mile Run Time:
High School/Club Rowing Program:
Current Boat (Varsity/JV/Novice, 8+/4+/4X/2X/1X):
High School/Club Rowing Coach:
Coach's Phone Number:
Coach's E-mail address:
Do you have any relatives in the military? (Yes or No-You may be eligible for a Presidential Nomination):
Have you enlisted in the NCAA Clearinghouse?:
Are you interested in the Naval Academy? (Very much, Yes, or No):
Other colleges you are interested in:
Who will you look to for advice about colleges?:

By submitting this questionnaire you hereby authorize the release of your academic transcript to the U.S. Naval Academy. You will then be redirected to the Navy Athletics home page.

This questionnaire is for evaluation purposes by our coaching staff. It is not an application for admission to the Naval Academy. If you desire to become a candidate for admission we recommend that you complete the questionnaire for the admissions office at: www.usna.edu/Admissions/steps.htm

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