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Personal Information
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Full Name:
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Date of Birth:
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SS#
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Complete Mailing Address (street/box, city, state, zip):
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Home Phone:
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Cell Phone:
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Best time to call:
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Email address:
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Height:
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Weight:
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Name of Parent(s) / Guardian:
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Father's Occupation:
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Mother's Occupation:
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Business phone for Father:
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Business phone for Mother:
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Where did your father go to school?
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Where did your mother go to school?
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Religious affiliation:
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Friends or relatives who have attended LRC: |
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Academic Information
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High School:
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High School Principal:
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High School Address:
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High School phone #:
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High School fax #:
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High School Counselor:
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GPA:
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Weighted GPA:
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Month/Year of Graduation:
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Class rank:
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Test Scores - ACT:
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Test Scores - SAT (three-part SAT):
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Test Scores - TOEFL (foreign students):
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University Major desired:
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Have you registered for the NCAA Clearing House?
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Yes
No |
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If yes, list 10-digit ID #:
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What other colleges are you considering?
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Medical Information
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Have you had any type of surgery?
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Yes
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If yes, what type:
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Have you ever, or do you now take medication for asthma?
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Yes
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If yes, please list the medication: |
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How often do you take this medication?
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Are you currently taking any type of medication?
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Yes
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If yes, what type?
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Athletic Information
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Swim Club:
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Coach:
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Phone #:
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High School Swim Team:
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Coach:
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Phone #:
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How long have you been swimming?
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Other sports:
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What are your major considerations when choosing a
college? [select as many as you wish] |
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When do you plan to commit?
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Please list your best times and in what events (short
course yards/long course meters):
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List 3 strengths as an athlete:
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List 3 weaknesses as an athlete:
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Approximate yardage per practice (mid-season):
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Kicking yardage:
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Pulling Yardage:
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Swimming yardage:
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List training aids used (paddles, buoys, etc.):
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Number of practices per week:
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Favorite sets:
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Please list any other information
to be taken into consideration upon evaluation of your questionnaire.
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