Personal Information
   Last Name*

   First Name*

    Social Security # *

Birthdate*

   Phone Number*

*Sex:      Male     Female

Address
  
Street*

 
City*


State*

 
Country*

 
  Zip Code*
  
E-mail Address

Academics
 
Academic Interests

  
ACT Score

  
SAT Score

  
G.P.A.

  
Class Rank

  
Graduation Date*

Parents
   
Father's Name

  
Father's Occupation

  
Mother's Name

  
Mother's Occupation

* Have you applied to NCAA Clearing House?    Yes      No     I Don't Know

* Have you applied for admission to Delta State University?    
Yes    No

High School
   Name of School*

   Name of Coach

   Coach's Phone Number

Swimming Club
   Name of Club

   Name of Coach

   Coach's Phone Number

Best Events and Time or Diving Scores

Is there anything else you would like for us to know about you?

Note:  While we appreciate information from all prospective athletes, we are not allowed by NCAA rules and regulations to contact you until September 1st of your Junior Year in High School.