Student-Athlete Interest Form
Providence Swimming & Diving
BACKGROUND INFORMATION
First Name:
Last Name:
E-mail:
Home Phone:
Cell Phone:
Street:
Town:
State:
Zip Code:
Country:
Date of Birth (mm/dd/yy):
Gender:
Height: ft inches
Weight (lbs):
Parent Names:
Mother: Job/College Attended:
Father: Job/College Attended:
ACADEMIC INFORMATION
Present School (HS or college):
Present Grade:
Present GPA (include scale):
Class Rank (include class size):
SAT Math:   SAT Critical Reading:
SAT Writing:
SAT Subject Test #1:  Score:
SAT Subject Test #2:  Score:
SAT Subject Test #3:  Score:
ACT:
ACT Math:
ACT English:
ACT Reading:
ACT Science:
Intended College Major:
Other Schools of Interest:
Other Schools of Interest:
Other Schools of Interest:
NCAA Clearinghouse #:
What year will you attend?**
Swimming & Diving INFORMATION

FREESTYLE (Personal Bests)
50
 100
 200
 500
 1000
 1650
BACKSTROKE (Personal Bests)
50
 100
 200
BREASTSTROKE (Personal Bests)
50
 100
 200
BUTTERFLY (Personal Bests)
50
 100
 200
IM (Personal Bests)
200
 400
DIVING(Personal Bests)
1-meter
6 Dives
 1-meter
11 Dives
 What is your 1-meter list?
3-meter
6 Dives
 3-meter
11 Dives

What is your 3-meter list?


Comments For Coaching Staff: