Prospective Student Athlete Questionnaire - Swimming & Diving

Please fill in as much information as possible
Required Fields in Bold

Personal Information

Name (First, M.I., Last)

Street Address

City

State

Zip Code

Area Code and Telephone Number

Cell Phone

E-Mail

Birthdate (MM/DD/YY)

Height

Weight

High School Graduation Year

Academic Area of Interest at UVa

High School Name

High School Grade Point Average

Class Rank

ACT/SAT Score


Athletic Experience

Eligibility Center ID Number

High School Counselor/Phone Number

Coach's Name / Phone Number

USS Club

USS Coach / Phone Number

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