PURDUE UNIVERSITY
SWIMMING & DIVING


PERSONAL INFORMATION

FIRST NAME  
MIDDLE NAME  
LAST NAME  
NICKNAME  
SSN  
GENDER  
DATE OF BIRTH  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
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  
MAIN EVENT  
HIGHEST LEVEL OF SWIM MEET PARTICIPATION  
NUMBER OF SERIOUS COMPETITIVE SEASONS - WINTER  
NUMBER OF SERIOUS COMPETITIVE SEASONS - SUMMER  
 

EVENTS (Example: 200 Free - 1:40.23, Example: 100 Free - 47.29)

EVENTS  
Short Course Yards Long Course Meters Short Course Meters
50 Free
100 Free
200 Free
500/400 Free
1000/800 Free
1650/1500 Free
100 Fly
200 Fly
100 Back
200 Back
100 Breast
200 Breast
200 IM
400 IM

DIVING  
6 Dives 11 Dives
1M Diving
3M Diving
Platform Diving
 

USS TEAM

USS TEAM NAME  
USS COACH'S FIRST NAME  
USS COACH'S LAST NAME  
USS COACH'S EMAIL  
USS 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.