Please fill out the following form if you have an interest in swimming for the N.C. A&T swim team.
This is not an official N.C. A&T University application, but merely a way to weigh your interest in the
program.                                  

First  Name   Middle Initial         

Last Name  

Address       
                   

City        
State      Zip

Home Phone        
E-Mail Address       
DOB      Age      

Grade (Current)     
Year of Graduation  

Father's Name    
Occupation      

Mother's Name       
Occupation       

Overall GPA     Core GPA         Class Rank  

Guidance Counselor's Name       
SAT (Math/Verbal/Total)     ACT  

Guidance Counselor's Phone  

Registered with NCAA Clearinghouse (Yes/No)  
PID #  

High School/Junior College       
Coach's Name      

Address       
                   

City                   
State          Zip

Coach's Office Phone           

If you are a Junior College transfer, will you graduate?     
Junior College GPA    

Club Team Name       
Coach's Name      
Coach's Phone           

Swimming Experience

Event One  

Top Times       

Event Two       

Top Times       

Event Three       

Top Times       

Height        Weight        
Honors & Awards  


Other Sports Played  

Other Data

Do you know anyone who is or has been enrolled at North Carolina A&T University?

Have you applied for admission?       
Have you visited the campus?