2023 USA Swimming National Diversity Select Camp- Application

May 4th-7th, 2023 at the Olympic & Paralympic Training Center in Colorado Springs, Colorado.

*Dates/Location subject to change due to COVID-19 regulations. Please note selection to the National Diversity Select Camp does not guarantee attendance in the event that the camp is cancelled. Applications must be received on or before February 10th. 2023 by 5PM MT. Athletes will be notified of their selection by March 3rd, 2023.

If you have any questions regarding the camp application and selection process, please reach out to Kristin Alfano, Manager of Program Operations, at kalfano@usaswimming.org.

First Name: *

Middle Name or Initial:

Last Name: *

Preferred Name:

Pronouns:

Athlete Email Address: *

Street Address: *

Address Line 2:

City: *

State: *

Zip Code: *

Athlete Phone Number: *

USA Swimming Member ID: *

Date of Birth: * +

Gender: *

Please list any medication or food allergies:

T-Shirt Size: *

Club Team Name: *

LSC: *

Parent / Legal Guardian Name: *

Parent / Legal Guardian Email Address: *

Parent / Legal Guardian Phone Number: *

Parent / Legal Guardian #2 Name:

Parent / Legal Guardian #2 Email Address:

Parent / Legal Guardian #2 Phone Number:

In 2023, the coach of a selected athlete is also invited to attend the National Diversity Select Camp in Colorado Springs, CO. The coach will be provided up to $200 in airfare reimbursement from USA Swimming. Housing, meals and local transportation for the coach will be provided by USA Swimming.

Name of the coach to be invited: *

Coach's Email: *

Coach's Phone Number: *

National Diversity Select Camp Eligibility: Athletes must represent an underrepresented community and/or an ethnically underrepresented population that is less than 10% of the current USA Swimming membership. These populations can include African American/Black, Hispanic/Latinx, Asian or Pacific Islander, Native American and others. Other athletes may be accepted if they represent another underrepresented demographic (e.g. LGBTQ+).

Ethnicity: *

Signature below testifies to the eligibility of the athlete:

Athlete Signature: *

clear

African American / Black	Hispanic / Latinx
Asian / Pacific Islander	Native American
Other (please explain) Other (please explain)