Front Rush

Fields marked with * are mandatory

General

Team (m/w)? *

*Please enter valid Team (m/w)?

Graduation Year *

*Please enter valid number

First Name *

*Please enter valid First Name

Last Name *

*Please enter valid Last Name

Preferred Name

*Please enter valid Preferred Name

Email Address *

*Please enter valid Email Address

Home Address 1 *

*Please enter valid Home Address 1

Home Address 2

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City *

*Please enter valid City

State *

*Please enter valid State

Zip *

*Please enter valid Zip

County *

*Please enter valid County

Country

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Home Number *

*Please enter valid number

Cell Phone Number *

*Please enter valid number

Date of Birth *

Open the calendar popup.

*Please enter valid Date of Birth

Favorite way to communicate *

e-mail

Phone

Text message

*Please enter valid Favorite way to communicate

Can we text you? *

*Please enter valid Can we text you?

Profile Image

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Background

1 Parent / Guard - Full Name *

*Please enter valid 1 Parent / Guard - Full Name

1 Parent / Guard - Phone # *

*Please enter valid 1 Parent / Guard - Phone #

1 Parent / Guard - Email *

*Please enter valid 1 Parent / Guard - Email

2 Parent / Guard - Full Name

*Please enter valid 2 Parent / Guard - Full Name

2 Parent / Guard - Phone #

*Please enter valid 2 Parent / Guard - Phone #

2 Parent / Guard - Email

*Please enter valid 2 Parent / Guard - Email

Do you know any Alumni from Lycoming College *

*Please enter valid Do you know any Alumni from Lycoming College

If so, Who? and Graduation year?

*Please enter valid If so, Who? and Graduation year?

Academic

Current High School *

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GPA *

*Please enter valid number

SAT

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ACT

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Other College Choices

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Intended Major *

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Activities, Clubs, Community Service

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Athletic

Teams *

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High School District or Region *

*Please enter valid High School District or Region

Club Name & LSC

*Please enter valid Club Name & LSC

Height

FeetInch

*Please enter valid Height

Specialty *

Butterfly

Backstroke

Breaststroke

Sprint Freestyle

Mid. Dist. Freestyle

Dist. Freestyle

Individual Medley

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List Best Times Below

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Event #1 *

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Event #1 Time *

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Event #1 Pool *

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Event #2 *

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Event #2 Time *

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Event #2 Pool *

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Event #3 *

*Please enter valid Event #3

Event #3 Time *

*Please enter valid Event #3 Time

Event #3 Pool *

*Please enter valid Event #3 Pool

Personal Contacts

Include any personal contacts you would like to share with this school.These contacts may receive emails, texts or calls for staff at the school.

First

Last

Main #

Secondary #

Cell #

Questionnaires