Introduction Section
WELCOME TO THE AZUSA PACIFIC SWIMMING QUESTIONNAIRE!!!
Questionnaire Code
(not required):
Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Country:
Address Type:
Street Address:
City:
State:
Zip:
Grad Year:
Date of Birth:
Email Address:
Home Phone:
Mobile Number:
FaceBook:
Twitter:
@
Instagram:
@
What is your connection to this university:
Parent(s) Information
Parent 1's First Name:
Parent 1's Last Name:
Parent 1's Gender:
Parent 1's Address (If Different):
Parent 2's First Name:
Parent 2's Last Name:
Parent 2's Gender:
Parent 2's Address (If Different):
Academic Information
{{item.text}} No schools matching "{{sd.searchText}}" were found.
School Name:
School Address:
School City:
School State:
School Zip:
School Phone#:
GPA:
SAT Composite:
ACT Composite:
Intended Major:
Have you Joined the Eligibility Center?
Eligibility ID:
Club Information
Club Name:
Club Address:
Club City:
Club State:
Club Zip:
Club Coach:
Club Coach Cell:
Club Coach Email:
Events

Important: Once you select an event all fields for that event are required and must be input correctly. If all fields are not filled out correctly then those values will not be logged with your application.

Distance Type Best 1 Best 1 Date Best 2 Best 2 Date
Event 1
Event 2
Event 3
Event 4
Event 5
Event 6
Other Questions
Do you have any online video? If so please provide the link.:
When you have completed this questionnaire please click submit questionnaire.
School Name:
OR :
State:
City:


Club Name:
Team Name:
Coach Last Name:
State:
City:


Club Name:
Team Name:
Club State:
Club Coach First Name:
Club Coach Last Name:
Club Coach Email:
Club Coach Mobile:

Do you still want to add the prospect?