SALEM INTERNATIONAL UNIVERSITY – Swimming

Recruiting Questionnaire

Name:_______________________________________________ Male/Female ______

Last First Middle

Mailing Address: _____________________________________________________

City ___________State/Prov. _______ Country ___________________Postal Code:________________

Telephone ( ) ___________E-mail Address ______________________________________________

High School: _______________ Graduation Date: __________

High School Address: ___________________________________________________

Junior College/College or University: _________________ Semesters: ___Units:___

SS # ______________D.O.B. _______ (HS/College)

GPA. _______Class Rank ____

SAT Scores: Verbal ____Math ____

ACT Scores: Eng____ Math___ Reading___ Science____ Comp___

Are You Registered with NCAA Initial Eligibility Center (Clearinghouse)? (Y/N) ______

Intended College Major: _____________________________

Anticipated Start Date:__________

Other Colleges that you are applying to: ________________________________________

Parents/Guardians Names and Occupations: _____________________________________

____________________________________

Number of Siblings (ages): ___________________________________________________

Water Polo Specific Information:

HT. ____ WT. _____ Dominant Hand: _____Ambidextrous? (Y/N) ______

H.S. Water Polo Coach _____________________Phone # ________________________

Club Water Polo Coach _____________________Phone # ______________________

Positions Played: __________________________ How many years playing water polo?____________

Speed: 50 Freestyle Time (y/m): ____ 100 Freestyle Time (y/m):____

Swimming Specific Information:

Swim Year Round? (Y/N) ____ How many years? ______

SWIMMING TIMES:

FREE FLY BACK BREAST IM

50 XXXX

100

200

400 XXXX XXXX XXXX XXXX

500 XXXX XXXX XXXX XXXX

OTHER

Please Complete and Return to: Curt Altschul - Men’s & Women’s Swimming & Water Polo Coach

Salem International University

223 West Main Street

Salem, West Virginia 26426

304-326-1475