November 4, 1998

Please print and mail to address at bottom of questionaire

PERSONAL DATE________

NAME______________________________________________ NICKNAME___________

ADDRESS_____________________________________________________________________

HOME PHONE()____________________________

BEST TIME TO CALL___________________________________

E-MAIL ADDRESS______________________________________

S.S.N._____________________ SEX________ BIRTHDATE____________

HEIGHT__________ WEIGHT___________

GRADUATION DATE__________ GPA_________

CLASS RANK________ COLLEGE MAJOR____________________

NAME OF YOUR CURRENT HIGH SCHOOL_____________________________________

HIGH SCHOOL ADDRESS__________________________________________________

HIGH SCHOOL PHONE ()________________FAX ()______________

HIGH SCHOOL GUIDANCE COUNSELOR_______________________________________

OTHER HIGH SCHOOLS ATTENDED___________________________________________

A.C.T.__________________________________________________ DATE TAKEN__________(MATH)(VERBAL) (SOC. SC.)(NAT. SC) (COMPOSITE)

S.A.T._____________________________________ DATE TAKEN_______________________(MATH)(VERBAL)(COMBINED)

ATHLETICS

USS/YMCA TEAM_____________________POOL PHONE()____________

COACH_____________________________HOME PHONE()_____________

HIGH SCHOOL TEAM__________________POOL PHONE()_____________

AVER. WEEKLY PRACTICES & YARDAGE: WINTER____________ SUMMER_______________

AVER. WEEKLY WEIGHT PRACTICES: WINTER____________ SUMMER______________

NUMBER OF YEARS AS A YEAR ROUND COMPETITIVE SWIMMER_____________________

COMPETITION RESULTS

CIRCLE YOUR BEST 3 EVENTS AND NOTE RELAY SPLITS WITH AN ASTERISK (*)

EVENTSCYSCMLCM EVENTSCYSCMLCM50 FREE 100 BACK100 FREE 200 BACK200 FREE 100 BREAST400/500 200 BREAST800/1000 100 FLY1500/1650 200 FLY200 IM 400 IM

MEDICAL

LIST ANY SWIMMING INJURIES (PAST & PRESENT)__________________________________

_____________________________________________________________________________

LIST ANY NON-SWIMMING INJURIES______________________________________________

LIST ANY MEDICAL CONDITIONS_________________________________________________

GENERAL

MOTHER’S NAME_______________________ OCCUPATION_____________________

ALMA MATER_____________

FATHER’S NAME_______________________ OCCUPATION_____________________

ALMA MATER______________

BROTHERS AND AGES____________________________________________________

SISTERS AND AGES_____________________________________________________

LIST ANY FRIENDS OR RELATIVES WHO ATTEND OR ATTENDED UK

_____________________________________________________________________

LIST HOBBIES AND INTERESTS__________________________________________

WHY ARE YOU INTERESTED IN U.K.?

___________________________________________________________________

WHY ARE YOU INTERESTED IN U.K. SWIMMING?

___________________________________________________________________

WHAT OTHER SCHOOLS ARE YOU CONSIDERING?

___________________________________________________________________

LIST IN ORDER OF PREFERENCE THE THREE BEST DATES FOR YOU TO VISIT U.K.

______________________________________________________________________

ON WHAT DATE DO YOU HOPE TO SELECT YOUR COLLEGE?

______________________________________________________________________

LIST HIGH SCHOOL ORGANIZATIONS YOU BELONG TO

_______________________________________________________________________

LIST ANY ACADEMIC OR ATHLETIC HONORS

______________________________________________________________________

______________________________________________________________________

RETURN TO: KENTUCKY SWIMMING CONTACT LANCASTER AQUATIC CENTER RM. 103 GARY CONELLY 1000 COMPLEX DR. DIRECT LINE: 606-257-9131 LEXINGTON, KY 40506-0219 FAX: 606-323-3601 E-MAIL: conelly@pop.uky.edu

Please print and mail to address above or fax to number above.