PURDUE UNIVERSITY
DIVING

PERSONAL INFORMATION

FIRST NAME  
MIDDLE NAME  
LAST NAME  
NICKNAME  
GENDER  
DATE OF BIRTH  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
BEST TIME TO CALL  
EMAIL  
MOTHER'S FIRST NAME  
MOTHER'S LAST NAME  
MOTHER'S EMAIL  
MOTHER'S WORK PHONE  
MOTHER'S CELL  
MOTHER'S ALMA MATER  
MOTHER'S OCCUPATION  
FATHER'S FIRST NAME  
FATHER'S LAST NAME  
FATHER'S EMAIL  
FATHER'S WORK PHONE  
FATHER'S CELL  
FATHER'S ALMA MATER  
FATHER'S OCCUPATION  
ARE YOU REGISTERED WITH THE NCAA ELIGIBILITY CENTER?  
PIN NO.  
WHAT IS YOUR CONNECTION TO PURDUE?  

ACADEMIC INFORMATION

HS NAME  

GRADUATION YEAR  
HS ADDRESS  
 
HS CITY  
HS STATE  
ZIP  
HS PHONE  
HS FAX  
CLASS RANK/SIZE  
GRADE POINT AVERAGE/SCALE  
ACT  
ACT DATE TAKEN  
SAT MATH  
SAT CRITICAL READING  
SAT WRITING  
SAT TOTAL  
SAT DATE TAKEN  
TOEFL (INTERNATIONAL RECRUITS ONLY)  
INTENDED MAJOR  
GUIDANCE COUNSELOR'S FIRST NAME  
GUIDANCE COUNSELOR'S LAST NAME  
GUIDANCE COUNSELOR'S EMAIL  

ATHLETIC INFORMATION

HEIGHT  
WEIGHT  
SERIOUS INJURIES/SURGERIES?  
 

DIVING

1M OPTIONALS  
3M OPTIONALS  
PLATFORM OPTIONALS  
 

USD TEAM

USD TEAM NAME  
USD COACH'S FIRST NAME  
USD COACH'S LAST NAME  
USD COACH'S EMAIL  
USD COACH'S CELL PHONE  
USD ADDRESS  
 
USD CITY  
USD STATE  
USD ZIP  
ANY ADDITIONAL COMMENTS?  
 
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.