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Introduction Section
UCLA Women's Water Polo
University of California, Los Angeles
Prospective Student-Athlete Questionnaire
* For any required questions that you don't have info for, you can put N/A
Note: Due to NCAA rules, we can only respond via email or phone call after June 15th following your Sophomore year. This is also the first date we are able to receive phone calls from you.
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Country:
United States
Anguilla
Antigua
Aruba
Bahamas
Barbados
Belize
Bermuda
Virgin Islands
Canada
Caymans
Clipperton Island
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Greenland
Grenada
Guadeloupe
Guatemala
Haiti
Honduras
Jamaica
Martinique
Mexico
Montserrat
Antilles
Nicaragua
Panama
Saint Barthélemy
Saint Kitts
Saint Lucia
Saint Martin
Saint Pierre
Saint Vincent
Trinidad and Tobago
Caicos Islands
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Falkland Islands
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
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Latvia
Liechtenstein
Lithuania
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Macedonia
Malta
Moldova
Monaco
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Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
Ukraine
United Kingdom
Vatican City
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Canary Islands
Cape Verde
Central African Republic
Chad
Comoros
Ivory Coast
Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Congo Republic
Reunion
Rwanda
Saint Helena
Sao Tome
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Western Sahara
Zambia
Zimbabwe
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei
Cambodia
China
Christmas Island
Cocos Islands
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Macau
Malaysia
Maldives
Mongolia
Burma
Nagorno-Karabakh
Nepal
Oman
Pakistan
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Timor-Leste
Turkmenistan
United Arab Emirates
Akrotiri and Dhekelia
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Caledonia
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Cook Islands
French Polynesia
Niue
Norfolk Island
Pitcairn Islands
Tokelau
Hong Kong
Address Type:
Billing
Business
Campus
Home
Mailing
Physical
Shipping
Street Address:
City:
State:
---Select State---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
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Iowa
Kansas
Kentucky
Louisiana
Maine
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Massachusetts
Michigan
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Mississippi
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Montana
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Ohio
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Mariana Islands
Minor Out. Is.
No State
Armed Forces Pacific
Zip:
Grad Year:
---Grad Year---
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
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2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
Male
Female
Another Legal Sex
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Parent 1's Occupation:
Parent 1's Email Address:
Parent 1's Cell Phone:
Parent 1's College:
Siblings (Names & Age):
Parent 2's First Name:
Parent 2's Last Name:
Parent 2's Gender:
Male
Female
Another Legal Sex
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Parent 2's Occupation:
Parent 2's Email Address:
Parent 2's Cell Phone:
Parent 2's College:
Guardian Information
Guardian's First Name:
Guardian's Last Name:
Gender:
Male
Female
Another Legal Sex
Not Available
Guardian's Occupation:
Guardian's Email Address:
Guardian's Cell Phone:
Guardian's College:
Living With:
Yes
No
Academic Information
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School Name:
School Address:
School City:
School State:
---Select State---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Mariana Islands
Minor Out. Is.
No State
Armed Forces Pacific
School Zip:
GPA:
SAT Test Date:
SAT Reading:
SAT Math:
SAT Writing:
SAT Composite:
ACT Test Date:
ACT Composite:
ACT English:
ACT Math:
ACT Reading:
ACT Science:
Intended Major:
Have you Joined the Eligibility Center?
Yes
No
Eligibility ID:
Club Information
Club Name:
Club City:
Club State:
---Select State---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Mariana Islands
Minor Out. Is.
No State
Armed Forces Pacific
Athletic Information
Height
Select
8' 11"
8' 10"
8' 9"
8' 8"
8' 7"
8' 6"
8' 5"
8' 4"
8' 3"
8' 2"
8' 1"
8' 0"
7' 11"
7' 10"
7' 9"
7' 8"
7' 7"
7' 6"
7' 5"
7' 4"
7' 3"
7' 2"
7' 1"
7' 0"
6' 11"
6' 10"
6' 9"
6' 8"
6' 7"
6' 6"
6' 5"
6' 4"
6' 3"
6' 2"
6' 1"
6' 0"
5' 11"
5' 10"
5' 9"
5' 8"
5' 7"
5' 6"
5' 5"
5' 4"
5' 3"
5' 2"
5' 1"
5' 0"
4' 11"
4' 10"
4' 9"
4' 8"
4' 7"
4' 6"
4' 5"
4' 4"
4' 3"
4' 2"
4' 1"
4' 0"
Weight (in lbs.)
College Preference 1
College Preference 2
College Preference 3
Positions
Position
Goalkeeper
Center
Defender
Utility
Attacker
Lefty
Attacker 1/2
Attacker 4/5
Other Questions
Please list your top times for the following events: 50 yd free,100 yd free, 200 yd free
:
What other events, if any, do you swim? What are your best times?
:
1) When would you like to make a decision on where you will attend college?
:
2) Do you know anyone that has attended UCLA? If so, who?
:
3) What would you most look forward to about being a student at UCLA?
:
4) Have you competed in any other sports besides water polo and swimming?
:
5) Who inspires you the most and why?
:
6) What would be your dream job (other than professional athlete)?
:
7) What are three fun things that people don't know about you?
:
8) What is your favorite quote (or quote that has special meaning to you)?
:
9) If you could only bring three things to a desert island, what would they be?
:
10) If you could only eat one meal for the rest of your life, what would it be?
:
11) If you could have dinner with ANY three people, who would they be?
:
12) If you could live anywhere in the world, what would be your top three places to live?
:
13) What are your favorite television shows or movies?
:
14) Who is your favorite music artist or genre?
:
When you have completed this questionnaire please click submit questionnaire.
School Name:
OR :
State:
---State---
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Mariana Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
No State
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
City:
Club Name:
Team Name:
Coach Last Name:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Mariana Islands
Minor Out. Is.
No State
Armed Forces Pacific
City:
Club Name:
Team Name:
Club State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Mariana Islands
Minor Out. Is.
No State
Armed Forces Pacific
Club Coach First Name:
Club Coach Last Name:
Club Coach Email:
Club Coach Mobile:
Do you still want to add the prospect?