UNIVERSITY OF RHODE ISLAND
SWIMMING QUESTIONNAIRE
NAME(Legal):________________________PHONE NO:__________________
HOME ADDRESS: (House No. and Street)___________________________
(Town/City, State, Zip)_____________________________________
(E-mail ADDRESS)________________________________
HIGH SCHOOL:___________________________________________________
CITY OR TOWN:__________________________________________________
SOCIAL SECURITY NO.: _____ __ _________
HAVE YOU REGISTERED WITH THE NCAA CLEARING HOUSE: _____________
HEIGHT:________ WEIGHT:________ BIRTHDATE: ______ ___ ___
ACADEMIC INFORMATION
COLLEGE AT URI TO WHICH YOU ARE APPLYING:______________________
HIGH SCHOOL RECORD: SAT'S/ACT'S: JR SR
CLASS RANK: __________ VERBAL: ______ _____
GPA: __________ MATH: ______ _____
OTHER ACTIVITIES/ACADEMIC HONORS:________________________
______________________________________________________
ATHLETIC INFORMATION
HOW MANY YEARS HAVE YOU BEEN SWIMMING? _________
HIGH SCHOOL COACH:_____________________ PHONE NO.:___________
CLUB OR YMCA TEAM:_____________________ YARDAGE/WEEK:________
CLUB COACH:____________________________ PHONE NO.:___________
BEST TIMES/SCORES (Please list at least four events):
EVENT BEST TIMES DATE MEET
_____________________ __________________ _________ ________
_____________________ __________________ _________ ________
_____________________ __________________ _________ ________
_____________________ __________________ _________ ________
_____________________ __________________ _________ ________
ATHLETIC HONORS/AWARDS:______________________________________
_____________________________________________________________
SEND TO: Michael W. Westkott PHONE: 401 874-2005 (Office)
Intercollegiate Athletics 401 789-6341 (Home)
University of Rhode Island E-Mail: swim@etal.uri.edu
Kingston, RI 02881