Go Navy
Go Navy
Navy Wrestling Questionnaire

Personal Information
Name:
Nickname:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Social Security Number:
Email:
Birthdate:
Father's Name:
Father's Occupation:
Father's Phone Number:
Mother's Name:
Mother's Occupation:
Mother's Phone Number:
I live with
(Mother,Father, Both, or Other):
Citizenship:
Glasses/Contacts:
Ethnic Background: 
White/Caucasian Black/African American Hispanic American Indian/Alaskan Native
Filipino Asian/Pacific Islander Other      

Academic Information
High School/Prep School:
ETS Code:
Address:
City, State, Zip:
Academic Interest:
Date of Graduation:
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:

Upon graduation I expect to have completed the following courses (Yes or No):

ALGEBRA I:
ALGEBRA II:
GEOMETRY:
CALCULUS:
PRE CALCULUS:
TRIGONOMETRY:
PHYSICS:
CHEMISTRY:
Other math courses taken:
Number of years of English taken in high school:
Have you registered with the NCAA Clearinghouse?:
Rate your level of interest in USNA at this time? (Very Interested, Interested, Might Be Interested):
Wrestling Information
High School Coach's Name:
High School Coach's Phone Number:

 Weight ClassRecordStatePlaceCadet/Jr.Nat.Place
Freshman Year
Sophomore Year
Junior Year
Senior

Height:
Natural Weight:
List any post-season wrestling accomplishments:
Are you interested in attending a post grad prep program:

Nomination Information

U.S. Senator (Name and State):

U.S. Senator (Name and State):

U.S. Congressman/District (Name and State):

If Senators and Congressman have already been contacted, please list the date contacted:

If you have a nomination, state your candidate number:

Is your father or mother on active military duty or retired with 20 years of active service?

Medical Information

Do you wear glasses or contact lenses?:

If yes, indicate to the best of your knowledge your uncorrected visual examination readings:

Left:

Right:

Is your vision 20/20 with contacts or glasses?

Are you color blind?:

Extracurricular Activities

Please indicate below all non-athletic extracurricular activities in which you have participated:

Upon submission of this questionnaire, you will 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