CAL STATE FULLERTON ATHLETICS

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					                          CAL STATE FULLERTON ATHLETICS
                            TRANSFER RESIDENCE REQUIREMENT WAIVER

A.     General Information
       1.      Student's Name
       2.      Student's Sport
       3.      Transferring From
       4.      Phone #                                         Fax #
B.     Initial-eligibility
       1.      Was this student recruited by your institution?         Yes        No
       2.      Was this student certified by the Clearinghouse?          Yes       No
               If no, was he/she a        partial, or a    non-qualifier
       3.     Did he/she sign a National Letter of Intent?         Yes       No
C.     Historical Data
       1.     Was this student enrolled at your institution?
                   Yes               No
               Date of entrance                            Date of withdrawal
               Check student's classification upon entrance:          FR    SO               JR   SR
       2.      Did this student participate in your athletic program?
                 Yes                 No
               What sport(s)           Academic year(s)        # Years of Eligibility Used




       3.      Is this student-athlete in good academic standing at your institution and would he/she have
               been academically eligible for competition were he/she to remain at your institution for the
               20 -20 year?
                   Yes               No


               If no, explain

       4.      Is this the first 4-year to 4-year transfer for this student-athlete?
                   Yes               No
               If no, previous 4-year institution

D.     Waiver Statement (If applicable)
       If the student qualifies, there is no objection to the student being granted an exception to the transfer
       residence requirements. In granting this waiver, I certify that all information contained in Section C of
       this form is accurate.

       ________________________________                                ______________________________
       Name                                                            Title
       ________________________________                                ______________________________
       Signature                                                       Date

Return this form to:   Dr. June F. Kearney, Assistant Director of Athletics, Compliance
                       California State University, Fullerton
P.O. Box 6810
Fullerton, CA 92834-6810
714-278-3431 714-278-5396 FAX

				
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