Name:  Year of Graduation: 

Date of Birth:   

E-mail Address: 

Address: 

City:  State:  Zip: 

Home Phone: 

Mother's Name: Father's Name:

High School: 

Coach: 

 Coach's Home Phone: 

Height:  Weight:  Position:  

Rank in Class: 

SAT/ACT:  GPA: 

Swimming Times/Water Polo Statistics:

Top College Choices:

Desired College Major:

Additional Information (years of swimming/water polo experience and positions played):