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Women's Swimming & Diving Recruiting Questionnaire

Women's Swimming & Diving

Please complete the following form with all available information. Hit the SUBMIT button at the bottom to electronically submit. If submitting a questionnaire by mail, please type or print all answers and mail to address listed at the bottom.

Indicates a Required Field
Last Name:
First Name:
Middle Initial:
Date of Birth:
Email Address:
Home Phone:
Cell phone number:
Street Address:
City:
State:
Zip:
50 Free:
100 Free:
200 Free:
500 Free:
1000 Free:
1650 Free:
100 Back:
200 Back:
100 Breast:
200 Breast:
100 Fly:
200 Fly:
200 I.M.:
400 I.M.:
1 Meter List:
1 Meter Score:
3 Meter List:
3 Meter Score:
Other sports participated in & number of years:
Athletic Honors Received:
Name of your current head coach:
Coach's Email Address:
Coach's Phone Number:
Name of your high school:
High school street address:
High school city:
High school state:
High school zip:
Cumulative Grade Point:
Class rank:
ACT/SAT Score (if available):
Graduation Date and Year:
Academic Interest Area(s):
Mother's Name:
Mother's Street Address:
Mother's City:
Mother's State:
Mother's Zip:
Mother's Phone Number:
Father's Name:
Father's Street Address:
Father's City:
Father's State:
Father's Zip:
Father's Phone Number:
Marital Status of Your Parents:
Married
Separated
Divorced
Deceased
Brothers & Sisters (Names & Ages):
Name / Signature:
Date:
Verification Code:
Questions or comments? Please email us at info@iowalakes.edu or call 712-362-2604 or 800-521-5054.
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