UNIVERSITY OF LA VERNE
WATER POLO

PERSONAL INFORMATION

FIRST NAME  
LAST NAME  
GRADUATION YEAR  
DATE OF BIRTH  
EMAIL  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
GENDER  
MOTHER'S FIRST NAME  
MOTHER'S LAST NAME  
MOTHER'S EMAIL  
FATHER'S FIRST NAME  
FATHER'S LAST NAME  
FATHER'S EMAIL  
SIBLINGS  

ACADEMIC INFORMATION

HS/JC NAME  

HS/JC ADDRESS  
 
HS/JC CITY  
HS/JC STATE  
ZIP  
HS/JC PHONE  
GRADE POINT AVERAGE  
INTENDED MAJOR  
CLASS RANK  
SAT TOTAL  
SAT CRITICAL READING  
SAT MATH  
SAT WRITING  
ACT  
ACADEMIC HONORS AND ACHIEVEMENTS  

ATHLETIC INFORMATION

HS COACH'S FIRST NAME  
HS COACH'S LAST NAME  
HS COACH'S EMAIL  
HS COACH'S CELL PHONE  
JC COACH'S FIRST NAME  
JC COACH'S LAST NAME  
JC COACH'S EMAIL  
JC COACH'S CELL PHONE  
POSITION  
DOMINANT HAND  
YEARS OF POLO  
HEIGHT  
WEIGHT  
50 FREE  
100 FREE  
OTHER SWIM TIMES  
CAP NUMBER  
ATHLETIC HONORS (I.E. ALL-CIF, NATIONAL LEVEL TEAM, ETC.)  
YOUR TOP THREE CHOICES FOR COLLEGE  
 

CLUB TEAM

CLUB TEAM NAME  
CLUB COACH'S FIRST NAME  
CLUB COACH'S LAST NAME  
CLUB COACH'S EMAIL  
CLUB COACH'S CELL PHONE  
PLEASE CERTIFY THAT YOU ARE A HIGH SCHOOL JUNIOR OR SENIOR, OR ARE A CURRENT COLLEGE STUDENT   Yes, it is AFTER September 1st of my Junior year of high school.
No, it is BEFORE September 1st of my Junior year of high school.