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East Tennessee State University

Center of Excellence for Sport Science and Coach Education


Weightlifting Questionnaire
Please fill out and email to: stoneme@etsu.edu

Name:_____________________________

DOB:

Weight Class: _________

Address:________________________________________________________________________

Phone:______________________________

US Citizen: Y N

Email:____________________________

Academic Classification: Freshman, Sophomore, Junior, Senior, Transfer

GPA:___________

Degree Program of Interest:_______________________________________

How many years have you been involved with weight-training?______________


How many years have you trained specifically for weightlifting?_____________
Why did you start weightlifting?_____________________________________________________________
_______________________________________________________________________________________
Please list your coaches (name and contact information) and team:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Please list weightlifting accolades:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Current Best Lifts:


Squat:__________

Snatch:__________

Clean & Jerk:__________

Squat:__________

Snatch:__________

Clean & Jerk:__________

Goals:

Team Goals:
Short Term:________________________________________________________________
________________________________________________________________________________________
Long Term:_______________________________________________________________________________
________________________________________________________________________________________
Injury History:______________________________________________________________________________________
__________________________________________________________________________________________________
Other Sports Experience:______________________________________________________________________________
Hobbies and Special Interests:___________________________________________________________________________
__________________________________________________________________________________________________

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