NJCAA Eligibility Affidavit by gtu20753


									                                                                                                                             OFFICE USE

                         NJCAA Eligibility Affidavit
                                                                                                                             Info Rqst:
                        SPORT: ______________________                          DATE: _____________
  Fill in all applicable information on this form to assist in determining eligibility for the NJCAA.
Personal Information:
    Name: ________________________________                         Birth Date: __/__/____ Social Security #: ___-___-_____
                         (First, Middle, Last)

    Hom e Address    _______________________________                          ______________________ ____________
                      Street Address                                          City, State, Zip Code

    Phone Number(s): ________________________________                    Email Address: ________________________________

    Emergency Phone Number(s): __________________________ Parents’ Names _______________________________
    Are you a United States Citizen or a Permanent Resident*?                 __ No _____
                                                                        Yes ___                       (*Holder of a Green Card or F1 VISA)

    Are you on another type of VISA?       Yes _____ No _____ If so, what type? _________________ ___________ ___

High School Information:
    High School(s) Attended: ________________________                      City, State & Country: _________________

    Graduated?: Yes* _____ No _____                                    High School Graduation Date (month/year): ____/______

    Check here if you have earned a *GED: ______                       GED: Date Earned (month/year): ____/______
   * Enclose a COPY of your High School Diploma or GED Certificate
Additional Information:
  1. Did you take any college credit classes while in high school? Yes* _____ No _____
     * If yes, from what college(s)? _________________________________________________________
     * If yes, please furnish transcript(s) from each college.
  2. Have you ever signed a Letter of Intent form with any institution? Yes _____ No _____

      If yes, specify the College: __________________________________ Date (day/month/year): ____/____/______

  3. Have you ever participated in a sport in a country other than the United States? Yes _____ No _____

      If yes, describe the situation and complete the following: ________________________________________________
      Sport(s)? _______________________               Country: ________________________               Dates: ___________________

  4. Have you ever been red-shirted for a season? Yes _____ No _____
     If yes, list when, where, and describe the situation: __________ __________
  5. Have you ever participated in practices/tryouts/exhibitions/scrimmages/games for an intercollegiate team other than
     this college? Yes _____ No _____ If yes, name the school, date, sport, and describe the situation: __________

  6. Have you ever played on a club team at a college or university? Yes _____ No _____ If yes, name the school,
     sport and the dates: _______________________________________________________________

  7. Have you ever received money beyond expenses for participating in any athletic event? Yes _____ No _____
     If yes, describe the situation: _________________________________________________________
                                                 (Please continue to the back of this page)
                                                       (NJCAA Eligibility Affidavit Continued)

                        List ALL Colleges Attended Full-Time and/or Part-Time after High School
                                         All transcripts from all previous institution MUST be included.

    College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)

    College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)

    College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)

    Additional Explanations:
    NOTE: If you attended college part-time or were not attending at all for any periods of time following high school
    graduation, please document your employment and military history during those times. If you were unemployed at any
    time, please list those dates as well. The NJCAA requires that we account for any time not enrolled full-time. Please use
    the space below. Please record months and years when referring to dates: _____________________________


     CERTIFICATION: I certify that:

     1. I will abide by all the rules for the athletic eligibility established by the NJCAA, MD JUCO and
       a. I am enrolled as a full-time undergraduate student in good academic standing.
       b. I will be continuously enrolled in at least 12 credits of college work during each semester while competing in athletics.
       c. I will maintain satisfactory academic progress.
       d. I will maintain at least a 1.75 cumulative grade point average as a first year participant.
       e. I will maintain at least a 2.0 cumulative grade point average as a second year participant.
       f. I must provide proof of high school graduation.
       g. I must provide a copy of all previous college transcripts.
       h. I must provide information regarding my residency as requested.
     2. Prior to making any changes that may affect my athletic eligibility, I will notify the
         Head Coach/Compliance Coordinator.
     3. I understand that any information falsely given or concealed pertinent to my eligibility will make me ineligible for
         further competition in all sports and will cause my institution to forfeit any contest in which I participated.
     4. Transfers Only: I was making satisfactory academic progress at my previous institution.
     I give the Anne Arundel Community College Athletic Department permission to check my college records for eligibility
     purposes and to release information on athletic eligibility and participation to the NJCAA and other higher education
     institutions. My coach does have permission to check my academic status for the purpose of monitoring my progress, and to
     release individual statistics and photographs to the media.
     I understand that information falsified or omitted can make me ineligible for ALL future college competition in
     compliance with the National Junior College Athletic Association Eligibility Rules.
     Student-Athlete Signature: ______________________________________________ Date: ______________________

      Parent Signature: ____________________________________________________                      Date: ______________________
     (If student-athlete is not 18 years old)

     Coach Signature: _____________________________________________________                       Date: ______________________

(Revised: July, 2007)

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