Questionnaire

Jeff Warrick, Diving Coach, Phone 515-294-5342, Fax 515-294-6046, Jacobson Athletic Building, Ames, Iowa 50011

Personal Information

Date   Phone   Cell
Name: Last   First   Middle
Address: Street   City   State   Zip
Fax no.     E-mail address
Date of birth   Height   Weight   Shoe size
Racial/ethnic information (optional):
American Indian or Alaskan Native , African American , White (not Hispanic) ,
Asian or Pacific Islander , Hispanic (Spanish American) , Nonimmigrant
Father's name     Occupation
Mother's name     Occupation
Brother's/sister's names and ages

Academic Information

High School
Address: Street City State Zip
Have you registered with the NCAA Clearinghouse? Yes No
Year of graduation Rank in class No. in class
GPA SAT ACT PSAT
Guidance counselor Phone
Extracurricular activities 1. 2. 3.
College academic interests 1. 2.

Athletic Information

High school coach
Phone (H)     (W)
Number of years you have participated in Diving
Club name     Club coach
Phone (H)     (W)

Diving Lists

1 Meter

3 Meter

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