OCCIDENTAL
SWIMMING & DIVING

PERSONAL INFORMATION

FIRST NAME  
LAST NAME  
DATE OF BIRTH  
GENDER  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
EMAIL  
PARENT/GUARDIAN 1 FIRST NAME  
PARENT/GUARDIAN 1 LAST NAME  
PARENT/GUARDIAN 1 EMAIL  
PARENT/GUARDIAN 1 WORK PHONE  
PARENT/GUARDIAN 1 CELL  
PARENT/GUARDIAN 1 COLLEGE (IF ATTENDED)  
PARENT/GUARDIAN 1 OCCUPATION  
PARENT/GUARDIAN 2 FIRST NAME  
PARENT/GUARDIAN 2 LAST NAME  
PARENT/GUARDIAN 2 EMAIL  
PARENT/GUARDIAN 2 WORK PHONE  
PARENT/GUARDIAN 2 CELL  
PARENT/GUARDIAN 2 COLLEGE (IF ATTENDED)  
PARENT/GUARDIAN 2 OCCUPATION  
SIBLINGS  
TOP 3 SCHOOLS  
OCCIDENTAL ALUMNI/STUDENTS KNOWN  
HOW DID YOU HEAR ABOUT US?  

ACADEMIC INFORMATION

HS NAME  

GRADUATION YEAR  
HS ADDRESS  
 
HS CITY  
HS STATE  
ZIP  
HS PHONE  
HS FAX  
CLASS RANK  
UNWEIGHTED ACADEMIC GPA  
ACT COMPOSITE  
SAT MATH  
SAT CRITICAL READING  
SAT WRITING  
SAT TOTAL  
INTENDED MAJOR  

ATHLETIC INFORMATION

50 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

100 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

200 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

400/500 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

800/900 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

1500/1650 FREE BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

100 BACK BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

200 BACK BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

100 BREAST BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

200 BREAST BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

100 FLY BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

200 FLY BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

200 IM BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

400 IM BEST TIMES  
TIME COURSE

DATE
TIME COURSE

DATE

1M DIVING  
TIME COURSE

DATE
TIME COURSE

DATE

3M DIVING  
TIME COURSE

DATE
TIME COURSE

DATE

PLATFORM DIVING  
TIME COURSE

DATE
TIME COURSE

DATE

HEIGHT  
WEIGHT  
 

CLUB TEAM

CLUB TEAM NAME  
CLUB COACH'S FIRST NAME  
CLUB COACH'S LAST NAME  
CLUB COACH'S EMAIL  
CLUB COACH'S CELL PHONE