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Panther C Symbol Men's Swimming


Head Coach: Mike Dickson  
Assistant Coach: Ryan Falcioni  
Diving Coach: Gary Bare  
Men's Swimming Office: 909/652-6305 Fax: 909/652-6295  


Prospect Questionnaire

The information provided in this form will be sent to the Chaffey College swim office. Additional questions should be directed to the swim office at 909/652-6305, or e-mail to mike.dickson@chaffey.edu. Thank you!

 

Last Name
  First Name
  Home Phone Number
  E-Mail Address
  Required
  Street Address
  City
  State
  Zip Code
   
  Birthplace (City and State)
  Birth Date
  Height
  Weight
   
  Planned Major
   
  High School
  High School Street Address
  City
  State
  Swim Coach
  Swim Coach Phone
   
  Graduation Month/Year
  PSAT Score
  SAT Score
  ACT Score
   
  Previous College Attended
  Street Address
  City
  State
  Swim Coach
  Swim Coach Phone
   
 
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CHAFFEY COLLEGE • 5885 Haven Avenue, Rancho Cucamonga, CA 91737-3002 • 909/652-6000
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