Northern State Swimming Questionnaire

Personal Information
Full Name (Last, First MI)


Male
Female

Mailing Address
City
State
Zip
Home Phone
Cell Phone
Social Security #
High School
Date of HS Graduation
GPA
ACT/SAT score
Area Of Interest
Years of HS Swimming

Other HS Sports Played
HS Academic Honors
HS Athletic Honors
   
Club Team

Club Coach

Club Coach's Phone

Years of Club Swimming

   

List Top Five Events
(and time - yards) 


Your E-mail address*: 
 
 
 
 
*This is a REQUIRED FIELD. If you do not have an e-mail address, 
type in your last name with NO SPACES!

Extra Information:

Hitting "Send" will e-mail the form directly to NSU's swimming program.
Hitting "Clear" will clear the form and not send it anywhere.
Thanks for your interest in Northern State women's swimming!

 

 
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