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Navy Women's Swimming Questionnaire

Personal Information

Name:
Address:
City:
State:
Zip:
Home Phone:
Social Security Number:
Email:
Birthdate:
Father's Name:
Father's Address(If Different):
Father's Phone Number:
Father's Alma Mater:
Mother's Name:
Mother's Address(If Different):
Mother's Phone Number:
Mother's Alma Mater:
Ethnicity:

Academic Information

High School:
Address:
City, State:
Zip:
Phone:
Coach:
Coach's Alma Mater:
Coach's Phone:
Graduation Date:
Guidance Counselor:
Intended Major(s):
GPA:
Class Rank:
Academic Honors:
PSAT Score V: M: Date Taken:
SAT Score V: M: Date Taken:
ACT Score V: M: Date Taken:

Top College Choices: 
1.
 
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4.
 
Have you received an application? (yes or no):
Have you contacted your senator/congressmen? (yes or no):
Havy you taken a physical examination with your Doctor? (yes or no):
Campus Visitation Date:

Swimming Information

Freestyle: 50:
100:
200:
500:
1000:
1650:
Backstroke: 50:
100:
200:
Breaststroke: 50:
100:
200:
Indiv. Medley: 200:
400:
  
Butterfly 50:
100:
200:
  

Club/YMCA Team Name/Address:
Club/YMCA Coaches Name:
Injuries/Recent Surgery:
List Swimming Honors and Awards:
Number of Workouts Per Week:
Average Weekly Yardage:
Weight Training/Dryland (Yes or No):

Upon submission of this form, you will be redirected to the Navy Athletics Women's Swimming Home Page.
Thank you for your interest.

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