Personal Information
First:
Last:
Address:
City:
State: Zip:
Date of Birth: Height:
Home Phone: Weight:
Cell Phone When is a good time to call?
email:

Family Information
Parents Names
Occupations
Colleges
E-mail Address


Athletic Information
High School Coach's Name:
High School Coach's Phone Number:
High School Coach's E-mail:
Name of Club/YMCA Team:
Club/YMCA Coach's Name:
Club/YMCA Coach's Phone Number:
Club/YMCA Coach's E-mail:
Do you mind if we call your club coach?
Would you like to hear from a Brandeis Swimmer?
Would you like to hear from an Alumni?
PLEASE LIST THE EVENTS YOU COMPETE IN AND
YOUR BEST TIME/PERFORMANCE AND DATE


1. Event: Time/Score: Date:
2. Event: Time/Score: Date:
3. Event: Time/Score: Date:
4. Event: Time/Score: Date:
5. Event: Time/Score: Date:
6. Event: Time/Score: Date:


Academic Information
High School:    
Address
Guidance Counselor
Counselor Phone/Email:
GPA Grad Yr.
Class Rank: Class Size:
PSAT Written: PSAT Verbal: PSAT Math:
SAT Written: SAT Verbal: SAT Math:
ACT English ACT Written ACT Math
ACT Science Composite ACT Score
SAT II
List Subject Names and Scores

AP Courses
Test Scores
Academic Interests
Academic Honors
Community Activities
Have you submitted an application?
Would you like to receive an application?
Are you applying early decision?
Will you be applying for financial Aid?
Have you completed your CSS/Profile?
Are you planning a campus visit? When?
List in order of preference, the Colleges you are
interested in attending (including Brandeis)
1.
2.
3.
4.