Minnesota State University Promotional Activities Request
1
Minnesota State University Athletic Department
Promotional Activities Request
This form, when signed by the agency/individual involved and approved by the MSU Athletic Department, allows the student-athlete’s name, picture or likeness to be used in community service/engagement or promotional activities. Completing this form does NOT guarantee approval of the request. NCAA Bylaw 12.5.1 Permissible.
***Please carefully read the following provisions regarding promotional activities***
NCAA Bylaw 12.5.1.1 — Institutional, Charitable, Education or Nonprofit Promotions. A member institution or recognized entity thereof (e.g., fraternity, sorority, or student government organization), a member conference or noninstitutional charitable, educational or nonprofit agency may use a student-athlete’s name, picture or appearance to support its charitable or educational activities or to support activities considered incidental to the student-athlete’s participation in intercollegiate athletics, provided the following conditions are met: (a) The student-athlete receives written approval to participate from the institution’s chancellor or president (or his or her designee), subject to the limitations on participants in such activities as set forth in Bylaw 17; (b) The specific activity or project in which the student-athlete participates does not involve cosponsorship, advertisement or promotion by a commercial agency except as follows: (1) Identification (e.g., graphics, voice over, on-screen test) of the commercial entity must explain the commercial entity’s affiliation with the permissible entity (e.g., entity is the official sponsor of the institution/event); (2) The appearance or description of the commercial product(s)/service(s) and/or the commercial entity’s logo(s) may be included, but may not exceed 25 percent of the total promotional activity. Further, language or action included in the promotion may not directly encourage the use or purchase of the commercial product or service (e.g., “drink this product”) with which the commercial entity is associated; (c) The student-athlete does not miss class; (d) All money derived from the activity or project go directly to the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity; (e) The student-athlete may accept actual and necessary expenses from the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity; (f) The student-athlete’s name, picture or appearance is not used to promote the commercial ventures of any nonprofit agency; (g) Any commercial items with names or pictures of student-athletes (other than items specified per Bylaws 12.5.1.6 and 12.5.1.7) may be sold only by the member institution, member conference or the NCAA or outlets controlled by the charitable or educational organization (e.g., location of the charitable or educational organization, site of charitable event during the event); and (h) The student-athlete and an authorized representative of the charitable, educational or nonprofit agency sign a release statement ensuring that the student-athlete’s name, image or appearance is used in a manner consistent with the requirements of this section.
***Pages 2 & 3 are to be completed by the sponsoring agency***
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
2
Promotional Activities Request
Minnesota State University Athletic Department
***To be completed by the sponsoring agency*** Name of Sponsoring Agency or Requesting Individual:
Department/Organization represented (if different than above):
Department/Organization website:
Agency Description (check one):
Institutional
Charitable
Educational
Contact Person: Name: Phone Number:
Fax Number:
Email: Event Information: Date of Event:
Start Time: (mm/dd/yyyy)
End Time: (Please include AM or PM)
(Please include AM or PM)
Street Address: City:
State:
Zip Code:
Please describe your event/request and what the student-athletes would be doing:
Ideally, how many student-athletes would you like at your event?
Please proceed to page 3 to complete the form.
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
3
Promotional Activities Request
Minnesota State University Athletic Department
***To be completed by the sponsoring agency*** Is this a fund-raising event?
Yes
No
Will the funds raised from the event directly or indirectly benefit prospects?
Yes
No
If yes, the University or its representatives may not participate in the event; if no, explain the use of the funds:
Will the event involve students who have stared the ninth grade?
Yes
No
Yes
No
If yes, how will they be involved?
Will you provide transportation or meals to the student-athletes? If yes, please explain:
Additional information:
I understand that student-athletes must not miss class for promotional or volunteer activities. I certify that I have read this form and the provisions of NCAA Bylaw 12.5.1.1 above, in its entirety and agree to the required terms and conditions. By checking this box and signing this form below, you certify that you are a representative or appointed individual of the agency listed in this form. Fraudulent submissions are punishable by harsh means. I acknowledge that I have read and agree to abide by the NCAA provisions regarding the use of a student-athlete’s name, picture, or appearance in the promotions or involvement of this activity. The approval of this request will be at the discretion of the Director of Athletics and Assistant Athletic Director of Compliance and Student Services.
___________________________________________
______________________
Signature of Authorized Representative
Date
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
4
Minnesota State University Athletic Department
Promotional Activities Request
For office use only: Approved?
Yes
No
Signature of Athletic Compliance Staff
Date
Please return Promotional Activities Requests to: Minnesota State University Athletics Attn: Nathan Christensen - Asst. AD for External Operations; or Brittany Heinz - Director of Marketing & Special Events 135 Myers Field House Mankato, MN 56001
OR Athletics Fax: (507) 389-2904
***Please allow at least (2) weeks for all Promotional Activities Requests responses***
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
Minnesota State University Athletic Department
Promotional Activities Request
This form, when signed by the agency/individual involved and approved by the MSU Athletic Department, allows the student-athlete’s name, picture or likeness to be used in community service/engagement or promotional activities. Completing this form does NOT guarantee approval of the request. NCAA Bylaw 12.5.1 Permissible.
***Please carefully read the following provisions regarding promotional activities***
NCAA Bylaw 12.5.1.1 — Institutional, Charitable, Education or Nonprofit Promotions. A member institution or recognized entity thereof (e.g., fraternity, sorority, or student government organization), a member conference or noninstitutional charitable, educational or nonprofit agency may use a student-athlete’s name, picture or appearance to support its charitable or educational activities or to support activities considered incidental to the student-athlete’s participation in intercollegiate athletics, provided the following conditions are met: (a) The student-athlete receives written approval to participate from the institution’s chancellor or president (or his or her designee), subject to the limitations on participants in such activities as set forth in Bylaw 17; (b) The specific activity or project in which the student-athlete participates does not involve cosponsorship, advertisement or promotion by a commercial agency except as follows: (1) Identification (e.g., graphics, voice over, on-screen test) of the commercial entity must explain the commercial entity’s affiliation with the permissible entity (e.g., entity is the official sponsor of the institution/event); (2) The appearance or description of the commercial product(s)/service(s) and/or the commercial entity’s logo(s) may be included, but may not exceed 25 percent of the total promotional activity. Further, language or action included in the promotion may not directly encourage the use or purchase of the commercial product or service (e.g., “drink this product”) with which the commercial entity is associated; (c) The student-athlete does not miss class; (d) All money derived from the activity or project go directly to the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity; (e) The student-athlete may accept actual and necessary expenses from the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity; (f) The student-athlete’s name, picture or appearance is not used to promote the commercial ventures of any nonprofit agency; (g) Any commercial items with names or pictures of student-athletes (other than items specified per Bylaws 12.5.1.6 and 12.5.1.7) may be sold only by the member institution, member conference or the NCAA or outlets controlled by the charitable or educational organization (e.g., location of the charitable or educational organization, site of charitable event during the event); and (h) The student-athlete and an authorized representative of the charitable, educational or nonprofit agency sign a release statement ensuring that the student-athlete’s name, image or appearance is used in a manner consistent with the requirements of this section.
***Pages 2 & 3 are to be completed by the sponsoring agency***
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
2
Promotional Activities Request
Minnesota State University Athletic Department
***To be completed by the sponsoring agency*** Name of Sponsoring Agency or Requesting Individual:
Department/Organization represented (if different than above):
Department/Organization website:
Agency Description (check one):
Institutional
Charitable
Educational
Contact Person: Name: Phone Number:
Fax Number:
Email: Event Information: Date of Event:
Start Time: (mm/dd/yyyy)
End Time: (Please include AM or PM)
(Please include AM or PM)
Street Address: City:
State:
Zip Code:
Please describe your event/request and what the student-athletes would be doing:
Ideally, how many student-athletes would you like at your event?
Please proceed to page 3 to complete the form.
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
3
Promotional Activities Request
Minnesota State University Athletic Department
***To be completed by the sponsoring agency*** Is this a fund-raising event?
Yes
No
Will the funds raised from the event directly or indirectly benefit prospects?
Yes
No
If yes, the University or its representatives may not participate in the event; if no, explain the use of the funds:
Will the event involve students who have stared the ninth grade?
Yes
No
Yes
No
If yes, how will they be involved?
Will you provide transportation or meals to the student-athletes? If yes, please explain:
Additional information:
I understand that student-athletes must not miss class for promotional or volunteer activities. I certify that I have read this form and the provisions of NCAA Bylaw 12.5.1.1 above, in its entirety and agree to the required terms and conditions. By checking this box and signing this form below, you certify that you are a representative or appointed individual of the agency listed in this form. Fraudulent submissions are punishable by harsh means. I acknowledge that I have read and agree to abide by the NCAA provisions regarding the use of a student-athlete’s name, picture, or appearance in the promotions or involvement of this activity. The approval of this request will be at the discretion of the Director of Athletics and Assistant Athletic Director of Compliance and Student Services.
___________________________________________
______________________
Signature of Authorized Representative
Date
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
4
Minnesota State University Athletic Department
Promotional Activities Request
For office use only: Approved?
Yes
No
Signature of Athletic Compliance Staff
Date
Please return Promotional Activities Requests to: Minnesota State University Athletics Attn: Nathan Christensen - Asst. AD for External Operations; or Brittany Heinz - Director of Marketing & Special Events 135 Myers Field House Mankato, MN 56001
OR Athletics Fax: (507) 389-2904
***Please allow at least (2) weeks for all Promotional Activities Requests responses***
Minnesota State University 135 Myers Field House Mankato, MN 56001 507.389.2018 MSUMAVERICKS.COM
11/14
