Student-Athlete Statement − Division III by BetsyY

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									Form No. 08-3c                                               Student-Athlete Statement − Division III                                         Academic Year 2008-09

                                                      For:     Student-athletes.
                                                   Action:     Sign and return to your director of athletics.
                                                Due date:      Before you first compete each year.
                                          Required by:         NCAA Constitution 3.2.4.5 and NCAA Bylaws 14.1.3.1 and 30.13.
                                                 Purpose:      To assist in certifying eligibility.
                                           Effective Date:     This NCAA Division III statement/consent form shall be in effect from the date this document
                                                               is signed and shall remain in effect until a subsequent Division III Student-Athlete
                                                               Statement/Drug-Testing Consent form is executed.



                      Name of Student-Athlete (Please Print)                                                             Name of Your Institution
This form has four parts: a statement concerning eligibility, a Buckley Amendment consent, a statement concerning the promotion of NCAA championships and other
NCAA events, and results of drug tests. You must sign all three parts in order to participate in intercollegiate competition.
Before you sign this form, you should read the Summary of NCAA Regulations provided by your director of athletics or read the bylaws of the NCAA Division III
Manual that deal with your eligibility. If you have any questions, you should discuss them with your director of athletics.
The conditions that you must meet to be eligible and the requirement that you sign this form are indicated in the following articles and bylaws of the Division III
Manual: Articles 10, 12, 13, 14, 15 and 16; Bylaws 14.1.3.1, 18.4 and 31.2.3. If you have questions you may contact the NCAA at 317/917-6222.

Part I: Statement Concerning Eligibility.
By signing this part of the form, you affirm that, to the best of your knowledge, you are eligible to compete in intercollegiate competition.
You affirm that you have read the Summary of NCAA Regulations or the relevant sections of the Division III Manual and that your director of athletics (or his or her
designee) gave you the opportunity to ask questions about the regulations.
You affirm that you meet the NCAA regulations for student-athletes regarding eligibility, recruitment, financial aid, amateur status and involvement in organized
gambling.
You affirm that you are aware of the NCAA drug-testing program and that you have signed the 2008-09 Drug-Testing Consent (Form 08-3f).
You affirm that you have reported to the director of athletics of your institution any violations of NCAA regulations involving you and your institution.
You affirm that you understand that if you sign this statement falsely or erroneously, you violate NCAA legislation regarding ethical conduct, and you will further
jeopardize your eligibility.


                                Name (Please Print)                                                     Date of Birth                                       Age


                           Signature of Student-Athlete                                                             Home Address (Street or P.O. Box)


                                        Date                                                                          Home City, State, and Zip Code
Sport(s)

Part II: Buckley Amendment Consent.
By signing this part of the form, you certify that you agree to disclose your educational records.
You understand that this entire form and the results of any NCAA-administered drug test you take are part of your educational records. These records are protected by
the Family Educational Rights and Privacy Act of 1974 and they may not be disclosed without your consent.
You give your consent to disclose only to authorized representatives of this institution, its athletics conference (if any) and the NCAA, the following documents:
     •     This form;
     •     Results of NCAA drug tests;
     •     Results of positive drug tests administered by non-NCAA national and international athletics organizations;
     •     Any transcript from your high school, this institution, or any junior college or any other four-year institutions you have attended;
     •     Pre-college test scores, appropriately related information and correspondence (e.g., testing sites and dates and letters of test-score certification or appeal), and
           where applicable, information relating to eligibility for or conduct of nonstandard testing;
     •     Graduation status;
     •     Your social security number and/or student identification number;
     •     Race and gender identification;
     •     Diagnosis of any education-impact disabilities;
     •     Accommodations provided or approved and other information related to any education-impact disabilities in all secondary and postsecondary schools.
     •     Records concerning your financial aid; and
     •     Any other papers or information pertaining to your NCAA eligibility.
You agree to disclose these records only to determine your eligibility for intercollegiate athletics, your eligibility for athletically related financial aid, for evaluation of
school and team success, for purposes of inclusion in summary institutional information reported to the NCAA (and which may be publicly released by it), for NCAA
longitudinal research studies and for activities related to NCAA compliance reviews. You will not be identified by name by the NCAA in any such published or
distributed information.
Further, you authorize the NCAA to disclose personally identifiable information from your educational records (including information regarding any NCAA violations
in which you may become involved while you are a student-athlete) to a third party (including, but not limited to, the media) as necessary to correct inaccurate
statements reported by the media or related to a student-athlete reinstatement case, infractions case or waiver request. You also agree that necessary case information
(i.e., information from your student-athlete reinstatement case, infractions case or waiver request) may be published or distributed to third parties as required by NCAA
bylaws, policies or procedures. You will not be identified by name by the NCAA in any such published or distributed information.


                          Name (Please Print)                                         Date                                   Signature of Student-Athlete

Part III: Promotion of NCAA Championships, Events, Activities or Programs.

You authorize the NCAA or a third party acting on behalf of the NCAA (e.g., host institution, conference, local organizing committee) to use your name or picture to
generally promote NCAA championships or other NCAA events, activities or programs.


                          Name (Please Print)                                         Date                                   Signature of Student-Athlete

Part IV: Results of Drug Tests.
A. No Positive Drug Test.
You affirm that you have never tested positive for a banned substance in a test administered by the NCAA and/or by a non-NCAA national or international athletics
organization for a banned substance; violated drug-testing protocol; or failed to show for a drug test. If you have ever tested positive to such a test, go to Part B below
and do not sign here.


                          Name (Please Print)                                         Date                                   Signature of Student-Athlete
B. Positive Drug Test.
If you have ever tested positive for a substance banned by the NCAA and/or by a non-NCAA national or international athletics organization; violated drug-testing
protocol; or failed to show for a drug test, the results must be declared here. The results of a non-NCAA national or international athletics organization positive drug
test must be reported by your director of athletics to the NCAA education services department. Should you later transfer, you are obligated to report NCAA positive
drug-test results to the respective institution.


           Date of Test                                     Organization Conducting Test                                                    Substance
C. Positive Test After Signing This Form.
Should you test positive for a substance banned by the NCAA and/or by a non-NCAA national or international athletics organization; violate drug-testing protocol; or
fail to show for a drug test at any time after you sign this statement, as described in the above paragraph, you must report the results to your director of athletics, who
must then report the results to the NCAA.


                          Name (Please Print)                                        Date                                     Signature of Student-Athlete


Form No. 08-3f                                                 Drug-Testing Consent − Division III                                           Academic Year 2008-09
You must sign this form to participate (i.e., practice or compete) in intercollegiate athletics. Per NCAA Bylaw 30.5-(b), the director of athletics or the director of
athletics' designee shall disseminate a list of banned drug classes to all student-athletes and educate them about products that might contain banned drugs. Please note
that the list may change during the academic year, that updates may be found on the NCAA Web site (i.e., www.ncaa.org) and you will be informed of the procedures
your athletic department will use to disseminate updates to the list.
The requirement that you sign this form is indicated in the following articles of the NCAA Division III Manual: Constitution 3.2.4.6 and Bylaws 14.1.4 and 30.5. If
you have any questions, you should discuss them with your director of athletics.



Drug-Testing Consent.
By signing this form, you affirm that you are aware of the NCAA drug-testing program, which provides:
A student-athlete who tests positive for a banned substance as set forth in Bylaw 31.2.3, shall be declared ineligible for further participation in postseason and regular-
season competition during the time period ending one calendar year after the student-athlete’s positive drug test. The student-athlete shall be charged with the loss of a
minimum of one season in all sports if the season of participation has not yet begun or a minimum of the equivalent of one full season of participation in all sports if the
student-athlete tests positive during his or her season of participation (i.e., the remainder of the contests in the current season and contests in the next season up to the
period of time in which the student-athlete was declared ineligible during the previous year). The student-athlete shall remain ineligible until the student-athlete tests
negative (in accordance with the testing methods authorized by the NCAA Executive Committee), and the student-athlete’s eligibility is restored by the NCAA Division
III Committee on Student-Athlete Reinstatement. [Bylaw 31.2.3]
A student-athlete who tests positive (in accordance with the testing methods authorized by the Executive Committee) shall be charged with the loss of a minimum of
one season of participation in all sports if the season of participation has not yet begun for that student-athlete or a minimum of the equivalent of one full season of
participation in all sports if the student-athlete tests positive during his or her season of participation (i.e., the remainder of the contests in the current season and
contests in the next season up to the period of time in which the student-athlete was declared ineligible during the previous year). The student-athlete shall remain
ineligible for all regular-season and postseason competition during the time period ending one calendar year (i.e., 365 days) after the student-athlete’s positive drug test
and until the student-athlete tests negative (in accordance with the testing methods authorized by the Executive Committee) and the student-athlete’s eligibility is
restored by the Committee on Student-Athlete Reinstatement. [Bylaw 18.4.1.5]
If the student-athlete who tested positive for any drug other than a “street drug” as defined in Bylaw 31.2.3.4 tests positive a second time for the use of any drug other
than a “street drug” as defined in Bylaw 31.2.3.4, he or she shall lose all remaining regular-season and postseason eligibility in all sports. If the student-athlete tests
positive for the use of a “street drug” after being restored to eligibility, he or she shall be charged with the loss of a minimum of one additional season of participation in
all sports and also shall remain ineligible for regular-season and postseason competition at least through the next calendar year. [Bylaw 18.4.1.5]
If a student-athlete transfers to another NCAA institution while ineligible, the institution from which the student-athlete transferred must notify the institution that the
student-athlete is ineligible. If the student-athlete immediately transfers to a non-NCAA institution while ineligible and competes in collegiate competition within the
365-day period at the non-NCAA institution, the student-athlete will be ineligible for all NCAA regular-season and postseason competition until the student-athlete
does not compete in collegiate competition for a 365-day period. Furthermore, the student-athlete must retest negative (in accordance with the testing methods
authorized by the Executive Committee), and the student-athlete’s eligibility must be restored by the Committee on Student-Athlete Reinstatement. [Bylaw 18.4.1.5]
The Executive Committee shall adopt a list of banned drugs and shall authorize methods for drug testing of student-athletes on a year-round basis. This list of banned
drugs and the procedure for informing member institutions about authorized methods for drug testing are set forth in Bylaw 31.2.3.4. The list is subject to change and
the institution and student-athlete shall be held accountable for all banned drug classes on the current list. The list is located on the NCAA Web site (www.ncaa.org) or
may be obtained from the NCAA health and safety staff in Education Outreach. [Bylaw 18.4.1.5]
You agree to allow the NCAA to test you in conjunction with any NCAA championship or in any postseason football game certified by the NCAA for the banned drugs
listed in Bylaw 31.2.3.
You agree to allow your drug-test sample to be used by the NCAA drug-testing laboratories for research purposes to improve drug-testing detection. Individual
samples will not be personally identified.
You were provided an opportunity to review the procedures for NCAA drug testing that are described in the NCAA Drug-Testing Program brochure.
You understand that this consent and the results of your drug tests, if any, only will be disclosed in accordance with the provisions of the Buckley Amendment Consent.
You agree to disclose your drug-testing results only for purposes related to your eligibility for participation in regular-season and postseason competition.
You agree that you have received a copy of the NCAA list of banned substances.
You affirm that you understand that if you sign this statement falsely or erroneously, you violate NCAA legislation regarding ethical conduct, and you will further
jeopardize your eligibility.
By signing below, you consent to be tested by the NCAA in accordance with the rules and regulations of NCAA drug-testing policy.


               Date                                                           Signature of Student-Athlete


               Date                                                Signature of Parent (if Student-Athlete is a minor)


                      Name of Student-Athlete (Please Print)                                            Date of Birth                                        Age


                       Home Address (Street or P.O. Box)                                                              Home City, State, and Zip Code
Sport(s)




                        What to do with this form:        Sign and return it to your director of athletics before you first compete.
                                                          This form is to be kept in the director of athletics' office for six years.
                        Any questions regarding this form should be referred to your school’s compliance office.
NCAA Banned-Drug Classes                                                                                                                  Attachment
2008-09                                                                                                                         Form 08-3f and 08-3f-1

The NCAA list of banned-drug classes is subject to change by the NCAA        (d) Diuretics and other urine manipulators:
Executive Committee. Contact NCAA education services or                           acetazolamide           hydrochlorothiazide
www.ncaa.org/health-safety for the current list. The term “related                bendroflumethiazide     hydroflumethiazide
compounds” comprises substances that are included in the class by their           benzhiazide             methyclothiazide
pharmacological action and/or chemical structure. No substance                    bumetanide              metolazone
belonging to the prohibited class may be used, regardless of                      chlorothiazide          polythiazide
whether it is specifically listed as an example.                                  chlorthalidone          quinethazone
Many nutritional/dietary supplements contain NCAA banned substances.              ethacrynic acid         spironolactone
In addition, the U.S. Food and Drug Administration (FDA) does not                 flumethiazide           triamterene
strictly regulate the supplement industry; therefore purity and safety of         furosemide              trichlormethiazide
nutritional dietary supplements cannot be guaranteed. Impure                                              and related compounds
supplements may lead to a positive NCAA drug test. The use of
supplements is at the student-athlete’s own risk. Student-athletes should    (e) Street Drugs:
contact their institution’s team physician or athletic trainer for further        heroin                    tetrahydrocannabinol
information.                                                                      marijuana3                  (THC)3

                                                                             (f) Peptide Hormones and Analogues:
Bylaw 31.2.3. Banned Drugs                                                        corticotrophin (ACTH)
The following is a list of banned-drug classes, with some examples of             growth hormone (hGH, somatotrophin)
substances under each class. No substance belonging to the                        human chorionic gonadotrophin (hCG)
banned drug class may be used, regardless of whether it is                        insulin like growth factor (IGF-1)
specifically listed as an example.                                                leutenizing hormone (LH)
                                                                                     (all the respective releasing factors of the above-
(a) Stimulants:                                                                       mentioned substances also are banned.)
amiphenazole            methylenedioxymethamphetamine                             erythropoietin (EPO)       sermorelin
amphetamine               (MDMA, ecstasy)                                         darbypoetin
bemigride               methylphenidate
benzphetamine           nikethamide                                          (g) Anti-Estrogens
bromantan               pemoline                                                  anastrozole
caffeine1 (guarana)     pentetrazol                                               clomiphene
chlorphentermine        phendimetrazine                                           tamoxifen
cocaine                 phenmetrazine                                             and related compounds
cropropamide            phentermine
crothetamide                                                                 (h) Definitions of positive depends on the following:
diethylpropion          phenylpropanolamine (ppa)                                1 for caffeine—if the concentration in urine exceeds 15 micrograms/ml.

dimethylamphetamine picrotoxine                                                  2 for testosterone—if the administration of testosterone or use of any

doxapram                pipradol                                                   other manipulation has the result of increasing the ratio of the total
ephedrine               prolintane                                                 concentration of testosterone to that of epitestosterone in the urine
(ephedra, ma huang)     strychnine                                                 to greater than 6:1, unless there is evidence that this ratio is due to
ethamivan               synephrine                                                 a physiological or pathological condition.
ethylamphetamine         (citrus aurantium, zhi shi, bitter                      3 for marijuana and THC—if the concentration in the urine of THC

fencamfamine             orange)                                                   metabolite exceeds 15 nanograms/ml.
meclofenoxate           and related compounds
methamphetamine
                                                                             31.2.3.4.1 Drugs and Procedures Subject to Restrictions
The following stimulants are not banned:
phenylephrine           pseudoephedrine
                                                                             The use of the following drugs and/or procedures is subject
                                                                             to certain restrictions and may or may not be permissible,
(b) Anabolic Agents:
                                                                             depending on limitations expressed in these guidelines
anabolic steroids
                                                                             and/or quantities of these substances used:
androstenediol            gestrinone
                                                                             (Revised: 8/15/89)
androstenedione           mesterolone
boldenone                 methandienone
                                                                             (a) Blood Doping. The practice of blood doping (the
clostebol                 methyltestosterone
                                                                             intravenous injection of whole blood, packed red
dehydrochlormethyl-       nandrolone
                                                                             blood cells or blood substitutes) is prohibited, and any evidence
testosterone              norandrostenediol
                                                                             confirming use will be cause for action consistent with that taken for a
dehydroepiandro-          norandrostenedione
                                                                             positive drug test. (Revised: 8/15/89, 5/4/92)
sterone (DHEA)             norethandrolone
dihydrotestosterone       oxandrolone
                                                                             (b) Local Anesthetics. The Executive Committee will permit the limited
(DHT)                     oxymesterone
                                                                             use of local anesthetics under the following conditions:
dromostanolone            oxymetholone
                                                                             (1) That procaine, xylocaine, carbocaine or any other local anesthetic
epitrenbolone             stanozolol
                                                                                 may be used, but not cocaine; (Revised: 12/9/91, 5/6/93)
fluoxymesterone           testosterone2
                                                                             (2) That only local or topical injections can be used (i.e., intravenous
                          tretrahydrogestrinone (THG)
                                                                                 injections are not permitted); and
                          trenbolone
                                                                             (3) That use is medically justified only when permitting the athlete to
                          and related compounds
                                                                                 continue the competition without potential risk to his or her health.
Other anabolic agents
                                                                             (c) Manipulation of Urine Samples. The Executive
clenbuterol
                                                                             Committee bans the use of substances and methods that alter the
                                                                             integrity and/or validity of urine samples provided during NCAA drug
(c) Substances Banned for Specific Sports:
                                                                             testing.
Rifle:
                                                                             Examples of banned methods are catheterization, urine substitution
       alcohol            pindolol
                                                                             and/or tampering or modification of renal excretion by the use of
       atenolol           propranolol
                                                                             diuretics, probenecid, bromantan or related compounds, and
       metoprolol         timolol
                                                                             epitestosterone administration. (Revised: 8/15/89, 6/17/92, 7/22/97)
       nadolol            and related compounds
                                                                             (d) Beta 2 Agonists. The use of beta 2 agonists is permitted
                                                                             by inhalation only. (Adopted: 8/13/93)

                                                                             (e) Additional Analysis. Drug screening for select nonbanned
                                                                             substances may be conducted for nonpunitive purposes.
                                                                             (Revised: 8/15/89)
Form No. 08-3f-1                              Drug-Testing Consent − Division III Year-Round Pilot                                             Academic Year 2008-09

                                                    For:      Student-athletes.
                                                Action:       Sign and return to your director of athletics.
                                               Due date:      Prior to your first practice or prior to the Monday of the institution’s fourth week of classes,
                                                              whichever date occurs first.
                                        Required by:          NCAA Constitution 3.2.4.6 and NCAA Bylaws 14.1.4 and 30.5.
                                              Purpose:        To participate in the Division III Drug-Education and Drug-Testing Pilot.




                     Name of Student-Athlete (Please Print)                                                               Name of Your Institution


TO: STUDENT-ATHLETE


Name of your institution:


The NCAA Division III Presidents Council agreed to a two-year drug-education and drug-testing pilot in Division III, which will incorporate year-round testing on
Division III campuses beginning in 2007-08. The two-year pilot is intended to provide Division III additionalinformation about drug deterrence in Division III. The
Presidents Council agreed to waive NCAA Bylaw 18.4.1.5.1 during this pilot testing only (this bylaw provides for a mandatory penalty for a positive drug test), so that
there will be no sanction for the individual student-athlete for a positive drug test under this pilot program. Individual student-athlete drug tests results from this pilot
drug testing will not be identified.

If you have any questions, you should discuss them with your director of athletics.



Drug-Testing Consent.

The NCAA Executive Committee shall adopt a list of banned drugs and shall authorize methods for drug testing of student-athletes on a year-round basis. This list of
banned drugs and the procedure for informing member institutions about authorized methods for drug testing are set forth in Bylaw 31.2.3. The list is subject to change
and the institution and student-athlete shall be held accountable for all banned drug classes on the current list. The list is located on the NCAA Web site
(www.ncaa.org) or may be obtained from the NCAA health and safety staff in the Education Outreach department. [Bylaw 18.4.1.5.2]

You agree to allow your drug-test sample to be used by the NCAA drug-testing laboratories for research purposes to improve drug-testing detection. Individual
samples will not be personally identified.

You were provided an opportunity to review the procedures for NCAA drug testing that are described in the NCAA Drug-Testing Program brochure.

You understand that this consent and the results of your drug tests, if any, only will be disclosed in accordance with the provisions of the Buckley Amendment Consent.

You agree that you have received a copy of the NCAA list of banned substances.

You affirm that you understand that if you sign this statement falsely or erroneously, you violate NCAA legislation regarding ethical conduct, and you will further
jeopardize your eligibility.

Lastly, you confirm that, in addition to signing this consent to be tested in the pilot, you must sign a drug-testing consent form to be tested during championship
participation per Bylaw 14.1.4.



              Date                                                             Signature of Student-Athlete


              Date                                                  Signature of Parent (if Student-Athlete is a minor)


                     Name of Student-Athlete (Please Print)                                             Date of Birth                                       Age


                      Home Address (Street or P.O. Box)                                                               Home City, State, and Zip Code
Sport(s)



                     What to do with this form: Sign and return it to your director of athletics prior to practice or the Monday of the institution’s
                     fourth week of classes, whichever occurs first. This form is to be kept in the director of athletics’ office for six years.

								
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