Diving Potential Student-Athlete Questionaire
Please fill in all areas and hit submit when finished.

Required Fields in Bold

 
Personal Information

Last Name
 
First Name
 
Preferred Name
 
Address
 
Gender
 
City
 
State
 
Zip Code
 
Home Telephone Number
 
Best time to be reached
 
Cell Phone Number
 
E-Mail Address
 
Age
 
Date of Birth
 
Height
 
Weight
 
Mother's Name
 
Mother's College
 
Father's Name
 
Father's College
 
 
Academic Information

High School
 
Graduation Date
 
Class Rank/Out of
 
G.P.A.
 
ACT/SAT
 
Address
 
 
Coach
 
Coach Phone
 
Registered for NCAA Clearinghouse?
 
Yes
No
University Major
 
Career Plans
 
Club Team
 
Club Coach
 
Club Coach Phone
 
 
Athletics Information

Please list your score for the 1-Meter (six dives).
 
Please list your score for the 1-Meter (11 dives).
 
Please list your score for the 3-meter (six dives).
 
Please list your score for the 3-meter (11 dives).
 
Please list your 1-meter FORWARD dive.
 
Please list your 1-meter BACK dive.
 
Please list your 1-meter REVERSE dive.
 
Please list your 1-meter INWARD dive.
 
Please list your 1-meter TWIST dive.
 
Please list any diving/academic accomplishments:
 
Please list any WIU Alumni, Students or Swimmers you know
 
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