Virginia Swimming
and Diving
Unofficial Home Page

Prospective Student-Athlete Questionnaire

Please submit the following student athlete questionnaire by:

1.   Sending an e-mail with the biographical information listed below to this e-mail address:   uvaswimcoach@earthlink.net

2.   Sending a fax with the biographical information listed below to 434-982-5271

3.   Mailing the biographical information listed below to the following address:

Mark Bernardino, Head Coach
Virginia Swimming & Diving
P.O. Box 400316
Charlottesville, VA 22904-4316

Personal Information

Name:

Date of Birth:

,

Eligibility Center ID Number :

Address:

City:

State:

Zip:

Phone Number:

E-mail:

Height:

Weight:

Parental Information

Parents' Name:

Parents' Occupation:

Name of College Parents Attended:

Academic Information

Graduation Year:

Current Year in High School:

High School:

H.S. Guidance Counselor:

H.S. Phone Number:

Class Ranking:


 

SAT:

Math:

Critical Reading:

Writing:

SAT 2:

Verbal (Written):

Math:

Please indicate: C1 C2

Please indicate subject (Biology, Chemistry, Physics, Spanish, French, etc.):

Subject Score:

ACT:

Please List AP Courses Completed or Currently Enrolled:

Academic Achievements:

Swimming Information

USS Club:

USS Club Coach:

USS Club Coach Phone Number:

High School Coach:

Times

Please indicate the distance and of your best times:

Short Course:

Yards:

Long Course:

Meters:

 

 

Times:

 

50

100

200

400

500

800

1000

1650

Free

Back

 

 

 

 

 

Breast

 

 

 

 

 

Fly

 

 

 

 

 

IM

 

 

 

 

 

 

 

Swimming Achievements:

 

 

Other Achievements and Comments: