Note: This form is not an official Brown University Application. It will be used by the coaching
staff to help profile prospective student-athletes. NCAA rules prohibit coaches from contacting
freshman and sophomores in high school. Only junior and seniors in high school are permitted
to use this form.

PERSONAL INFORMATION

Name:
                         Last                                 First                             Middle
Sex: Male Female
Home Phone Number: Cell Phone Number:
E-Mail:
Street Address:
City: State: Zip:
Date of Birth (mm/dd/yy):      Height (ft'in"):  Weight (lbs):

Father's Name: Occupation:
College:

Mother's Name: Occupation:
College:

ACADEMIC INFORMATION

High School: Graduation Year: Select 2007 2008 2009 2010 2011
Street Address: City: State: Zip:
Phone Number: Counselor's Name:

GPA: on a scale        Class Rank: of

PSAT: Math Verbal Writing PSAT Date (mm/dd/yy):

SAT: Math Verbal Writing SAT Date (mm/dd/yy):

SAT II:
Test    Score
Test    Score
Test    Score

ACT: ACT Date (mm/dd/yy):

**Brown requires the SAT and two SAT II subjects of your choice or the ACT test.

What academic area(s) do you plan on pursuing in college?

Please list anyone you know who is attending or has attended Brown:

List your top three universities in order of preference (include Brown if appropriate):
1. 2. 3.

Will you need financial assistance to attend Brown? Yes No

In the box below, please explain why you are interested in Brown:

DIVING INFORMATION

How long have you been diving competitively (yrs)? Current Club
Club Coach:   Club Coach Phone:   Club Coach E-mail:

HS Coach: HS Coach Phone:

Do you compete in any other sports? (please list)

Please list your diving achievements:

Diving List (please use dive #'s that you currently perform regularly):

1M

3M:

High Scores:

1m: high score number of dives

3m: high score number of dives

Platform: high score number of dives

Please use the box below for additional comments:

If you have not already sent a video or DVD of practice or meets, please do so ASAP.

Brown Swimming & Diving, 225 Hope Street, Box 1874, Providence, RI 02912
E-mail: Guy_Pollino@brown.edu
Fax: (401) 863-1188