Ursuline College
ATHLETIC DEPARTMENT PHILOSOPHY AND MISSION STATEMENT ............................................................. 1 RULES COMPLIANCE ..................................................................................................................................... 2 Institutional Control .................................................................................................................................. 2 Shared Responsibility ................................................................................................................................ 2 Compliance Responsibilities ..................................................................................................................... 2 Athletic Director .................................................................................................................................... 2 Compliance Coordinator ....................................................................................................................... 3 Head & Assistant Coaches..................................................................................................................... 4 Faculty Athletics Representative (FAR) ................................................................................................. 5 Registrar’s Office ................................................................................................................................... 6 Financial Aid Office ............................................................................................................................... 6 Office of Admission ............................................................................................................................... 7 Certificate of Compliance.......................................................................................................................... 7 RULES EDUCATION ........................................................................................................................................ 8 Athletic Staff & Coaches ........................................................................................................................... 8 Student-Athletes ....................................................................................................................................... 8 Compliance Committee ............................................................................................................................ 9 Faculty & Staff ........................................................................................................................................... 9 Alumnae/Alumni & Boosters .................................................................................................................... 9 Prospective Student-Athletes ................................................................................................................. 10 RULES INTERPRETATIONS ........................................................................................................................... 11 RULES VIOLATIONS & INVESTIGATIONS...................................................................................................... 11 Secondary Violation ................................................................................................................................ 11 Major Infraction ...................................................................................................................................... 11 Procedures For Violations ....................................................................................................................... 12 Procedures For Investigations ................................................................................................................ 12 Procedures For Reporting Violations ...................................................................................................... 13 Violations Involving Other NCAA Institutions ......................................................................................... 14
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Letters of Admonishment & Reprimand ................................................................................................. 14 SPORTSMANSHIP & ETHICAL CONDUCT ..................................................................................................... 15 Unethical Conduct................................................................................................................................... 15 Gambling & Sports Wagering.................................................................................................................. 16 DRUGS & ALCOHOL ..................................................................................................................................... 17 Athletic Department Drug & Alcohol Policy ........................................................................................... 17 NCAA Drug Testing Policy ....................................................................................................................... 22 Medical Exceptions & Supplements........................................................................................................ 23 NCAA Banned Drug Classes..................................................................................................................... 24 NCAA TOBACCO POLICY .............................................................................................................................. 24 PERSONNEL ................................................................................................................................................. 25 Assistant, Graduate, Volunteer and Contractual Coaches or Personnel ................................................ 25 Athletically-Related Outside Income ...................................................................................................... 25 Eligibility Lists & Roster Procedures........................................................................................................ 26 ADMISSION ................................................................................................................................................. 28 First-Year Students .................................................................................................................................. 28 Transfers ................................................................................................................................................. 28 International Students ............................................................................................................................ 29 INITIAL ELIGIBILITY ...................................................................................................................................... 30 NCAA Eligibility Center ............................................................................................................................ 30 Academic Certification ............................................................................................................................ 30 Amateurism Certification ........................................................................................................................ 31 TRANSFERS .................................................................................................................................................. 32 Permission To Contact ............................................................................................................................ 32 Other Institution’s Student-Athletes .................................................................................................. 32 Ursuline College Student-Athletes ...................................................................................................... 32 Transfer Appeal Process...................................................................................................................... 33 Transfer Eligibility.................................................................................................................................... 35 CONTINUING ELIGIBILITY ............................................................................................................................ 36 Full-Time Standing .................................................................................................................................. 36 9 Hour Rule ............................................................................................................................................. 37 24 Hour Rule ........................................................................................................................................... 37
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Regular Academic Year Hours/18 Hour Rule .......................................................................................... 38 Good Academic Standing & GPA (Grade-Point-Average) ....................................................................... 38 Ursuline Academic Standing & Incomplete Grade Policy ................................................................... 39 Designation of Degree Program.............................................................................................................. 39 Progress-Toward-Degree ........................................................................................................................ 40 Exceptions To Progress-Toward-Degree ................................................................................................. 40 SUMMER SESSION PROCEDURES ............................................................................................................ 41 Summer at Another Institution ........................................................................................................... 41 Summer at Ursuline ............................................................................................................................ 41 STUDENT-ATHLETE ACADEMIC PROBATION POLICY .............................................................................. 42 OTHER ELIGIBILITY REQUIREMENTS ....................................................................................................... 44 ELIGIBILITY TIMELINE .............................................................................................................................. 45 SEASONS OF COMPETITION .................................................................................................................... 47 HARDSHIP WAIVERS................................................................................................................................ 47 STUDENT-ATHLETE ACADEMIC RESPONSIBILITY ........................................................................................ 50 Missed Class Policy.................................................................................................................................. 50 FINANCIAL AID PROCEDURES...................................................................................................................... 51 Procedures for Prospective Student-Athlete Package Estimates ........................................................... 51 Procedures for Initial Grant-In-Aid to Prospective Student-Athletes ..................................................... 51 Procedures for Changes to Grant-In-Aid During an Award Period ......................................................... 53 Procedures for Renewal of Grant-In-Aid to Returning Student-Athletes ............................................... 54 Procedures for Reduction/Non-Renewal for Returning Student-Athletes ............................................. 54 Appeals Procedure: Reduction, Non-Renewal, Cancellation .................................................................. 55 Procedures for Non-Institutional Outside Financial Aid ......................................................................... 56 RECRUITING ................................................................................................................................................ 57 Coaches Certification Test ...................................................................................................................... 57 Documentation ....................................................................................................................................... 58 Official “Paid” Visits ................................................................................................................................ 58 Student-Athlete Hosts............................................................................................................................. 59 Unofficial Visits ....................................................................................................................................... 60 TRYOUTS ..................................................................................................................................................... 61 Prospective Student-Athletes ................................................................................................................. 61
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Enrolled Students/Walk-Ons................................................................................................................... 61 AWARDS & BENEFITS .................................................................................................................................. 63 Extra Benefits .......................................................................................................................................... 63 Complimentary Admissions .................................................................................................................... 63 Student-Athlete Awards ......................................................................................................................... 64 Varsity Awards ........................................................................................................................................ 64 Multisport Student-Athletes ................................................................................................................... 65 Occasional Meals .................................................................................................................................... 65 CAMPS & CLINICS ........................................................................................................................................ 66 Institutional Camps & Clinics .................................................................................................................. 66 Outside Camps & Clinics ......................................................................................................................... 67 STUDENT-ATHLETE EMPLOYMENT ............................................................................................................. 68 Off-Campus Employment........................................................................................................................ 68 On-Campus Employment ........................................................................................................................ 68 Academic Year Procedures: ................................................................................................................ 68 Summer Session Procedures:.............................................................................................................. 68 PLAYING & PRACTICE SEASONS .................................................................................................................. 69 Playing Season Declarations ................................................................................................................... 69 Daily/Weekly Hour Limitations & Logs ................................................................................................... 69 Countable Athletically Related Activities ................................................................................................ 71 Voluntary Athletically Related Activities................................................................................................. 72 Competition Records .............................................................................................................................. 72 OUTSIDE COMPETITION .............................................................................................................................. 73 All Sports Other Than Basketball ............................................................................................................ 73 Basketball ................................................................................................................................................ 73 Procedures For All Outside Competition Approval ................................................................................. 73 Appendix 1 - Booster Education ................................................................................................................. 74 Appendix 2 – Drug Testing Consent & Release of Information Form ......................................................... 75 Appendix 3 – Suspicion Based Testing Form............................................................................................... 76 Appendix 4 – Volunteer/Independent Contractor Athletic Personnel Agreement .................................... 77 Appendix 5 – Outside Coaching Approval Form ......................................................................................... 79 Appendix 6 – Athletically-Related Outside Income Form ........................................................................... 80
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Appendix 7 – Permission Request – Other Schools .................................................................................... 81 Appendix 8 – Permission to Contact-Release Request Form...................................................................... 82 Appendix 9 – Permission Letter – Ursuline Student ................................................................................... 83 Appendix 10 – Eligibility Tracer – Release Form ......................................................................................... 84 Appendix 11 – Transfer Student-Athlete Eligibility Evaluation Form ......................................................... 85 Appendix 12 – Historical Questionnaire ..................................................................................................... 86 Appendix 13 – Registration Form ............................................................................................................... 88 Appendix 14 – Course Change Form ........................................................................................................... 89 Appendix 15 – Change of Major Form ........................................................................................................ 90 Appendix 16 – Transient Student Form ...................................................................................................... 91 Appendix 17 – Transient Summer Email ..................................................................................................... 92 Appendix 18 – NCAA Drug Testing Consent Form ...................................................................................... 93 Appendix 19 – NCAA Student-Athlete Statement ...................................................................................... 96 Appendix 20 – NCAA HIPAA Form ............................................................................................................. 102 Appendix 21 – G-MAC Sportsmanship Form ............................................................................................ 103 Appendix 22 – Ursuline Promotional Authorization Form ....................................................................... 104 Appendix 23 – G-MAC Medical Hardship Form ........................................................................................ 105 Appendix 24 – Grant-In-Aid Request Form ............................................................................................... 106 Appendix 25 – Athletic Scholarship Letter ................................................................................................ 107 Appendix 26 – Returning Student-Athlete Scholarship Letter.................................................................. 108 Appendix 27 – Official Visit Authorization Form....................................................................................... 109 Appendix 28 – Expense Reports ............................................................................................................... 110 Appendix 29 – Student-Athlete Host Agreement ..................................................................................... 112 Appendix 30 – Liability Release Waiver-Prospects ................................................................................... 113 Appendix 31 – Unofficial Visit Form.......................................................................................................... 114 Appendix 32 – Tryout Request Form ........................................................................................................ 115 Appendix 33 – Occasional Meal Form ...................................................................................................... 116 Appendix 34 – Institutional Camp/Clinic Form ......................................................................................... 117 Appendix 35 – Liability Release Waiver ALL Minors ................................................................................. 119 Appendix 36 – Outside Camp/Clinic Approval Form ................................................................................ 120 Appendix 37 – Student-Athlete Employment Form.................................................................................. 121 Appendix 38 – Federal Work Study Certification & Application Form ..................................................... 122
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Appendix 39 – Declaration of Playing Season Form – Team Sports ......................................................... 123 Appendix 40 – Declaration of Playing Season Form – Individual Sports .................................................. 124 Appendix 41 – Countable Athletic Related Activities (CARA) Form .......................................................... 125 Appendix 42 – Competition Record .......................................................................................................... 126 Appendix 43 – Outside Competition Form ............................................................................................... 127
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Booster Education for Ursuline College Alumnae/Alumni and Friends Ursuline College is responsible for the actions of coaches, student-athletes and staff, as well as alumnae/alumni, boosters and fans. The following information is intended to help athletic boosters and organizations so they can best support college athletes without putting the institution at risk. BOOSTERS What is a booster? You are a Booster, or Representative of Athletics Interest, if you: Have participated in or ever have been a member of a booster organization that supports Ursuline athletics; Have made any financial contribution to the athletics department or any athletic organization; Have been involved in the recruitment of a prospect or have been asked to assist in the recruitment of a prospective student-athlete; Have provided or are providing benefits to an enrolled student-athlete or his or her relatives or friends; Have otherwise been involved in promoting Ursuline College athletic program in any way; Have helped arrange employment for student-athletes; Are a parent or guardian of an enrolled student-athlete; NOTE: Once someone has been identified as a Booster/representative of Ursuline athletics, they will retain that identity forever. RECRUITING What is a prospective student-athlete? A prospective student-athlete is any person who has begun classes in the ninth grade. In addition, a student who has not started classes for the ninth grade becomes a prospective student-athlete, if the institution provides a benefit or assistance not provided to prospective students in general. A prospective student-athlete remains so even after signing a National Letter of Intent or accepting financial aid and until they report for the first day of classes. What are Boosters prohibited from doing? Contacting a prospect in person on or off campus; Writing or telephoning a prospect or member of the prospect’s family; Making arrangements for the prospect or the prospect’s relatives or friends to receive money or financial aid; Providing transportation for a prospect or the prospect’s family or friends to visit the campus; Providing free tickets or reduced priced tickets to attend an athletic event to the prospect or the prospect’s family or friends; Entertaining coaches of prospects.
What are boosters permitted to do? Notify coaches about prospects in your area; Attend athletic contests where prospects compete, but may not contact the prospect or prospect’s relatives; Continue existing friendships with families of prospects, but not attempt to recruit.
ENROLLED STUDENT-ATHLETES What contact can Boosters have with currently enrolled student-athletes? A booster may not provide a student-athlete any benefit or special arrangement that would not be offered to the rest of the general student population. This would include: May not entertain student-athletes or their friends or family; May not purchase a meal or beverage for a student athlete; May not use the name or picture of an enrolled student-athlete to advertise, recommend, or promote any product or service; May not provide awards or gifts to student-athletes; May not allow a student-athlete to use a telephone to make free calls, or allow use of a free or discounted automobile; NOTE: An enrolled student-athlete may be invited to a booster’s home for an occasional home cooked meal, but may not be taken to a restaurant. NCAA regulations do not permit sponsor families or adopt-a-player arrangements. EMPLOYMENT A student-athlete may be employed so long as compensation is only for work actually performed, at a rate commensurate with the going rate in that locality for similar work, and the student-athlete was not hired based on athletics ability. Contact the Athletic Director before employing prospects or student-athletes. NOTE: Employment may be arranged for a prospect provided the employment does not begin before the completion of the prospects senior year. INSTITUTIONAL CONTROL Ursuline College is responsible for the actions of boosters and booster support groups. Boosters are regulated by the same NCAA rules and regulations placed upon all institutional athletics staff members. Ask before you act. Contact the Athletic Director Cindy McKnight or Compliance Coordinator Micki Stewart if you have questions.
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URSULINE COLLEGE DRUG TESTING AUTHORIZATION AND RELEASE OF INFORMATION
I acknowledge receipt of a copy of Ursuline College’s Intercollegiate Athletics’ Drug Policy. I also acknowledge that I have read, understand and agree to comply with this policy. It is understood that signing and returning this consent form is a prerequisite to participating in athletics at Ursuline College. It is further understood that I will forgo an opportunity to play intercollegiate athletics at Ursuline College if I refuse to sign this consent form. I further authorize the Head Athletic Trainer at Ursuline College to make confidential releases to the Head Coach of any intercollegiate sport, in which I am a team member, the Athletic Director, the Compliance Coordinator, the team physician, and my parents/guardians (if I am a minor), of all information, including test results and records, pertaining to me, as a student-athlete, and obtained under the College’s drug screening/testing policy.
Date: __/__/__ Student-Athlete (Print)
Student-Athlete (Signature)
Intercollegiate Sport (s)
Date: __/__/__ Parent (print) – if minor
Parent (signature) – if minor
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REQUEST FOR REASONABLE SUSPICION TEST Please fill out the following information for personally observed and not otherwise reasonably explained changes in the appearance or behavior of the athlete.
Name of Athlete:
Sport(s): ____________________________
Your Name: (If Coach – Sport you Coach): Please detail below your personally observed and/or unexplained changes in the athletes appearance, behavior, and/or performance that would lead you to suspect the athlete is using/abusing prohibited substances. Reasonable suspicion may be based on, but is not limited to: 1. Observed possession or use of substances appearing to be prohibited drugs 2. Previous positive drug test, refusal to take a drug test, or failure to appear for a drug test 3. Observed abnormal appearance, conduct or behavior that may cause someone to suspect the use or abuse of a banned substance. Examples of abnormal appearance, conduct or behavior may include, but are not limited to significant decline in academic or athletic performance, missing classes, significant weight gain or loss, increased injury rate or illness, lethargy, agitation, nervousness, short temper, or acts of violence Please make sure your descriptions are detailed and include dates and times if possible. Attach additional sheets if necessary. Please return this form to the Head Athletic Trainer in a sealed envelope.
Signature:
Date: __/__/__ 76
Volunteer / Independent Contractor Athletic personnel Agreement Ursuline College (“the College”) is a member institution of the National Collegiate Athletic Association (“NCAA”) and is subject to NCAA bylaws, rules, and regulations. In order to serve as a volunteer or independently contracted coach or other athletic personnel for Ursuline College, you must agree to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA. SERVICES TO BE RENDERED & FOR WHICH SPORT(S): DURATION OF SERVICES: CHECK ONLY ONE BOX:
Volunteer
Independent Contractor
BELOW SECTION TO BE COMPLETED BY VOLUNTEER OR INDEPENDENT CONTRACTOR FULL NAME: HOME ADDRESS (VOLUNTEERS): BUSINESS ADDRESS (CONTRACTORS): PHONE NUMBER & EMAIL ADDRESS: LIST ALL EMPLOYMENT & OTHERS CONTRACTING YOUR SERVICES: HAVE YOU EVER WORKED AS/FOR A SPORTS AGENT, FINANCIAL ADVISOR, ATHLETIC SCOUTING OR RECRUITING SERVICE, OR REPRESENTATIVE OF AN AGENT, ADVISOR, OR SCOUT/ RECRUITER (E.G., “RUNNER”)?
YES
NO
If Yes, please explain:
My signature below indicates the following:
I understand and agree that the head coach, athletic director, and/or appropriate administrator of the College shall determine my duties and responsibilities to the College as a volunteer or independently contracted coach.
I understand and acknowledge that I am not an employee of Ursuline College and this Agreement is not a contract of employment, nor is it intended to create an employment relationship of any kind.
While performing services under this Agreement, I agree to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA.
I acknowledge that I have received copies of the relevant bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA, and agree to carefully review these documents prior 77
to performing any services for the College under this Agreement. I further acknowledge and understand that the NCAA may consider me to be an “institutional staff member” for purposes of its bylaws, rules, and regulations.
I understand that my failure to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA, while performing services under this Agreement, may lead to disciplinary or corrective action, including but not limited to: suspension of services (without pay for contractors) or permanent termination of services without any further obligation on behalf of the College (and without pay for contractors). I understand and agree that this provision shall govern over any other conflicting provision contained herein or in any other agreement I may be a party to with the College.
I agree to report to the appropriate College officials any knowledge I may have of violations of NCAA bylaws, rules, and regulations involving Ursuline College or its representatives. I also understand that I may be required to certify in writing, on an annual basis, that I have in fact reported any such knowledge I may have of violations to the appropriate College officials. I further agree to fully cooperate with any investigation conducted by the College and/or the NCAA into possible rule violations.
I understand that under NCAA Bylaws, I am prohibited from: o Contacting and evaluating prospective student-athletes off-campus (unless certified & authorized by the College). o Scouting recruits or opponents off-campus (unless certified & authorized by the College). o Promoting Ursuline athletics or sport programs (unless certified & authorized by the College). o Providing private sport lessons (unless younger than 9th grade) & working any sport camps/clinics that are not open to all.
For Volunteers Only: I understand and agree that I am prohibited from receiving any compensation from the College for services rendered under this Agreement, and the opportunity afforded to me by the College to work with and to share my knowledge with Ursuline student-athletes is sufficient consideration in exchange for the obligations incurred herein.
For Independent Contractors Only: I understand that the College requires me to maintain adequate insurance throughout the duration of this Agreement in amounts previously specified by the College and I agree to furnish the College with proof of such insurance coverage.
I understand that this Agreement shall expire upon the conclusion of the Duration of Services indicated above.
AGREED UPON BY THE FOLLOWING: __________________________________________ Volunteer or Independent Contractor (Signature)
Date ____/____/____
__________________________________________ Head Coach (Signature) if only one sport
Date ____/____/____
APPROVAL: __________________________________________ Athletic Director (Signature)
Date ____/____/____
__________________________________________ Compliance Coordinator (Signature)
Date ____/____/____
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Coaches who wish to do any private lessons, or coach local sports clubs (or any other athletic team outside of Ursuline College) must receive approval from the Compliance Coordinator prior to performing any coaching activities/duties. To receive approval, submit this completed form to the Compliance Coordinator along with any additional documentation required below. Once approved, the coach will receive a copy of the signed/approved form to confirm approval and begin coaching activities.
13.11.2.4 Local Sports Clubs In sports other than basketball, an institution's coach may be involved as a participant or in instructional or coaching activities in the same sport for a local sports club or organization located in the institution's home community, provided all prospective student-athletes participating are legal residents of the area (within a 100-mile radius of Ursuline). Further, in clubs or leagues involving multiple teams, the 100-mile radius is applicable only to the team with which the institution's coach is involved; however, it is not permissible for the coach to assign a prospect who lives outside the 100-mile area to another coach. A coach may be involved with club located in the institution's home community that includes prospects participating in a sport other than the coach's sport, regardless of where they reside. A coach also may be involved in activities with individuals who are not of prospective student-athlete age (before the 9th grade), regardless of where they reside.
13.11.3.8 Private Lessons An institution’s equestrian, golf or tennis coach may teach private equestrian, golf or tennis lessons to a prospective student-athlete provided the following are met: 1) The coach makes lessons available to the general public; 2) Fees charged are at a rate commensurate with fees charged to all individuals; 3) Prior written approval is received annually from the institution’s president; 4) Fees are not paid by individuals or entities other than the prospect’s relatives or legal guardians; 5) The institution keeps on file documentation of fees charged for the private lessons and the name of any individual receiving any portion of the fee.
(Check which applies in this instance): Local Sports Club High School or Summer League Team Private Lessons (Only permitted for prospect-aged individuals if in Golf/Tennis by Golf/Tennis coaches-attach sheet stating fees & individuals) Other – Please Specify: _________________________________ (Check any that apply in this instance): All members of the team are not of prospect age (under 9th grade). The team is in a sport other than what is coached at Ursuline College. The club or team is located in the home community of Ursuline College. All prospects on this team are legal residents of the area-within 100 miles of Ursuline College (Attach list of team members & permanent addresses). (Initials) (Initials)
No prospects have been reassigned to another team due to my participation. The club or team is not sponsored by Ursuline’s Athletic Department or any booster of Ursuline College.
Coach Name
Start Date
End Date
Club or League Name
Sport
Team Name
Club/League Address
Director’s Name
Director’s Phone #
By submitting and signing this form, I confirm the information contained is accurate and truthful. I also understand that all outside income from my outside coaching must be reported annually on the Athletically-Related Outside Income Form collected in August of each year.
Approved Denied Coach Signature
Date
Compliance Initials
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This form is to be used by all staff members as means of reporting athletic-related income and benefits received from sources outside the institution. A coach must receive annual written approval from the Athletic Director to: 1) RECEIVE any athletically-related income and benefits from sources outside the College. 2) USE directly or by implication the institution’s name or logo in the endorsement of commercial products or services. 3) SIGN any contractual agreements outside of Ursuline College. STAFF NAME
SPORT/OFFICE
ACADEMIC YEAR
DATE
Check here if no outside income was earned for the year. SOURCE
OVERALL # OF EVENTS
DESCRIPTION
SPEAKING ENGAGEMENTS ENDORSEMENTS TV OR RADIO COMMERCIALS/APPEARANCES CHARITABLE WORK SPORTS CAMPS & CLINICS LOCAL SPORTS CLUBS OTHER (PLEASE SPECIFY)
Staff Signature
Date
Athletic Director Signature
Date
Compliance Coordinator Signature
Date
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Micki Stewart
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NAME: ______________________________________
SPORT: ______________________________________
Have you discussed your desire to transfer with the head coach?
____ Yes (Date:________) ____ No
(UC policy requires student-athletes to notify head coaches before permission/release will be given. It’s recommended for studentathletes to meet with head coach & both parties complete & sign this form - then turn it in to the Compliance Office IMMEDIATELY.)
Reason(s) for leaving: ________________________________________________________________________________ Institution(s) to which you would like Permission to Contact letter sent: _______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
NCAA Bylaw 13.1.1.2 Four-Year College Prospective Student-Athletes An athletics staff member or other representative of the institution’s athletics interests shall not make contact with the studentathlete of another NCAA four-year collegiate institution, directly or indirectly, without first obtaining the written permission of the first institution’s athletics director (or an athletics administrator designated by the athletics director) to do so, regardless of who makes the initial contact. If the institution decides to deny a student-athlete’s request to permit any other institution to contact the student-athlete about transferring, the athletics director (or his or her designee) shall inform the student-athlete in writing, within 14 consecutive calendar days from receipt of a student-athlete’s written request, that he or she, on request, shall be provided a hearing conducted by an institutional entity or committee outside of the athletics department.
____________________________________________ Student-Athlete Signature Date
_________________________________________ Head Coach Signature
_________________
________________
Date
Any objection to permission to contact? ____ Yes ____ No Any objection to full release? ____ Yes ____ No NOTES: ____________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
Date completed form received by coach or athletic administration: ________________ FOR COMPLIANCE USE ONLY Approved: ______ Denied: ______
Date: _______________ Date SA Notified: _______________
Appeal/Hearing Notification Given: _____ Yes (Date:___________)
No: ______
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Micki Stewart
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Micki Stewart
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STUDENT NAME: SPORT:
NAME OF INSTITUTION
2YR/4YR
DATES ATTENDED
PT/FT
HOURS
GRAD Y/N
TOTAL NUMBER OF FT SEMESTERS:
TRANSFERRABLE GPA: TRANSFERRABLE HOURS: DECLARED MAJOR (IF APPLICABLE):
QUALIFIER PARTIAL QUALIFIER NON QUALIFIER 2-YEAR REQUIREMENTS:
4-YEAR REQUIREMENTS:
N/A 9 SEM HRS PREVIOUS TERM N/A 12 SEM HRS AVG PER F/T TERM N/A 6 SEM HRS TRANSFERRABLE ENGLISH N/A 3 SEM HRS TRANSFERRABLE MATH
TRANSFER RELEASE FORM RECEIVED 9 TRANSFERRABLE SEM HRS PREVIOUS TERM
EXCEPTION(S) USED:
ELIGIBLE
NOT ELIGIBLE
DATE EVALUATION COMPLETED: COMPLETED BY:
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Name:
Today’s Date:
Sport(s):
Date of Birth:
Cell Phone:
Email:
LOCAL ADDRESS: (if off-campus check who you live with): Teammate Friend Parents Alone Spouse Other #/Street or Dorm Name/Room #
City
PERMANENT ADDRESS:
State
Zip
___________________________________________________________________________________________________________ #/Street
City
EMERGENCY CONTACT:
State
Zip
Name: ___________________________________________________ Relationship: ______________________________________ ___________________________________________________________________________________________________________ (Put “same” if same as permanent above) #/Street
City
State
Zip
Cell: _____________________________________________ Home Phone: _____________________________________________
HIGH SCHOOL GRADUATED FROM: ___________________________________________________________________________________________________________ Name
City
State
Month/Year Graduated
PRIOR COLLEGIATE ENROLLMENT (excluding summer school): 1) _________________________________________________________________________________________________________ School
Month/Year 1st Attended
Month/Year Last Attended
Sports Played: _______________________________________________ # of Years: _______________ 2) _________________________________________________________________________________________________________ School
Month/Year 1st Attended
Month/Year Last Attended
Sports Played: _______________________________________________ # of Years: _______________
EMPLOYMENT (everyone signs below): I understand that if I obtain new off-campus employment at any time throughout the year I must fill out a Student-Athlete Employment Form (found online). I also understand that any money paid for any employment must be for work actually performed. ___________________________________________________________________________________________________________ Student-Athlete (print)
Student-Athlete (signature)
Date
Do you currently have a job? Yes No Employer Name: __________________________________________________ Job Title, Duties & Pay: ________________________________________________________________________________________ 86
FINANCIAL AID: Do you have any outside scholarships that were not awarded by the government or Ursuline College?
Yes No
If Yes, please answer the following: Name(s): ___________________________________________________________________________________________________ Amount(s):__________________________________________________________________________________________________ Granting Organization(s): ______________________________________________________________________________________ Did any of these awards restrict where you could go to school?
Yes No
If Yes how?__________________________________________________________________________________________________
AMATEURISM & ELIGIBILITY: All Student-Athletes Have you ever accepted a loan, payment of expenses (travel, lodging, meals) or agreed orally or in writing to be represented by an agent or professional sports organization? Yes No Returning Student-Athletes Have you ever wagered a bet on a college or professional athletic contest since becoming a student-athlete? Have you competed in any organized competition, other than for Ursuline, since this time last year? If “Yes”, please give details :
Yes No
Yes No
__________________________________________________________________________________ __________________________________________________________________________________ Freshmen Student-Athletes Have you competed in any organized competition since requesting your NCAA amateurism certification? If “Yes”, please give details:
Yes No
__________________________________________________________________________________ NEW TRANSFERS OR NEW UPPERCLASSMAN ATHLETES – ONLY! Since graduating from high school, have you ever competed in organized athletics competition, either as an individual or as a member of a team that was not one of the college or university teams listed previously? Yes No If Yes, please explain:
*ALL STUDENT-ATHLETES*
If you have not continuously attended college as a full-time student each semester or quarter since graduating from high school, please describe your activities during that period you were not in school (i.e. work, military, church mission) and the dates of that time. Dates:
Reason:
Dates:
Reason:
RECRUITMENT STATUS: Did any coaches from Ursuline College Athletics initiate telephone calls or visit you, or a member of your family, off of Ursuline’s campus for the purpose of encouraging you to attend Ursuline College and participate in athletics? Yes No
I certify, upon penalty of ineligibility for intercollegiate athletics, that all statements contained within this document are complete and accurate, to the best of my knowledge. I also understand my responsibility to comply with all NCAA and Ursuline College requirements. If any of the information I have supplied in this report changes during the year, I will notify the Compliance Coordinator as soon as possible. Student-Athlete (Signature)
Date
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SSN/Student ID:________________________________________ Last Name:
Registration Form Fall 2017
First Name:
Middle Name
Address: City:
State:
Zip code
Phone:
Sex M F
Birth date
Ethnicity:
Marital Status:
Hispanic/Latino Y or N
Religious Preference:
Citizenship:
Check one or more
1-White 2-Black 4-Alaskan/American Indian 5-Asian 7- Native Hawaiian
1-Single 2-Married 3-Widowed 4-Divorced 5-Separated 6-Religious
Pending Date of Program Completion Educational Goal
Education Father: Education Mother
County
Catholic Jewish Protestant Other Not Declared
4-Permanent Resident List Country
May December BA Bachelor of Arts MA Master of Arts CC – Certificate of Completion
G-Middle School /Jr High H-High School G-Middle School /Jr High H-High School
Year ___________________ BSN Bachelor of Science in Nursing MSN Master of Science in Nursing No Specific Program
C-College or beyond O-Other/Unknown C-College or beyond O-Other/Unknown
Full Time
Employment Status Business Name Emergency Contact Name
U United States Citizen 1- F1 Visa- List Country
Not Employed Part Time Business Phone ( ) Emergency Contact Phone ( )
COMPLETE ALL OF THE ABOVE INFORMATION Students who have not attended for the past 24 months or more must be apply for readmission. Dept
No.
Sect
*Grade Option
Credit Hours
M
T
W
R
F
S
Instructor
Total Credit Hours
*Grade Option: P = Pass/No Credit
AD=Audit Grade Option Refer to the current Ursuline College Catalog for restrictions.
Alternate – please indicate an alternate course(s) in the event one of more courses are closed
Student E-Mail Address: Student Signature: Advisor Signature:
Date: Date:
Please note: Schedules WILL NOT be processed if the student has an outstanding financial obligation. Schedules WILL NOT be processed without an advisor signature.
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COURSE CHANGES SSN or ID#: ___________________________________________ DATE: ________________________________
NAME: _________________________________________________ ARE YOU A STUDENT ATHLETE?
YES___
SEMESTER: _________ YEAR: _________
NO___
Faculty Athletics Representative (FAR) Signature:________________________
ADDS Dept. Code
Course No.
DROPS *AU=Audit
Sect
CR
PN=Pass/ No Credit
Instructor
Dept. Code
Course No.
*AU=Audit Sect
CR
PN=Pass/ No Credit
Instructor
Drop all courses for the current term
*AU=Audit; PN= Pass No Credit grade options. Refer to current college catalog for grade option requirements. Reason: ___________________________________________________________________________________________ Advisor: __________________________________________________________
Date: _____________________
Student: __________________________________________________________
Date: _____________________
Distribution:
Student Service Center – Original
Financial Aid Office – Yellow
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CHANGE MAJOR/MINOR/CERTIFICATE/ADVISOR OR ADDITION OF SECOND MAJOR/MINOR/CERTIFICATE Effective for: ____________year
_____Fall
_____Spring
_____Summer
SSN/ID#________________________________________ Date: _____________________________ Name: ________________________________________________________________________________ Mailing Address: ___________________________________________________________________ Home Phone: ____________________________ Cell/Work Phone:______________________ I request a change of Advisor I request a change of { } Major
{ } Minor { } Certificate
From:_____________________________________________ To:________________________________________________ I request adding a { } Major { } Minor { } Certificate In:______________________________
Important: a change of major does not signify entry into the following programs: Nursing, education, social work, and long term care administration. Please follow the specific department of division procedures for formal admission into the program. I realize that this change might necessitate my taking additional courses and I am willing to do so in order to fulfill any requirements of my new academic major. ________________________________________________________________________________________________________________________ Student’s signature Date Approved By:_________________________________________________________________________________________________________ Current Advisor (please forward the student’s file to the new advisor) Your new advisor is:_________________________________________________________________________________________________ Office of ACADEMICaFFAIRS:_______________________________________________________________________________________ Date The office of Academic Affairs will return a copy of this form to you.
Original: Registrar Copy: Student Original Advisor New Advisor Revised 3/10
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TRANSIENT STUDENT FORM NAME:_____________________________SS#/ID#_________________________D ATE_______ MAILING ADDRESS___________________________________________________ STATUS: FRESHMAN___SOPHOMORE___JUNIOR___SENIOR___ Expected Graduation Date____ THIS STUDENT IS IN GOOD ACADEMIC STANDING (WITH G.P.A. 2.0 OR ABOVE) AT URSULINE COLLEGE.
PERMISSION TO REGISTER AT: COLLEGE OR UNIVERSITY_____________________________________________ FOR THE: SEMESTER(S) ____
FALL SEMESTER
QUARTER(S)
YEAR __________
____ FALL QUARTER
_____ SPRING SEMESTER
____ SPRING QUARTER
_____ SUMMER SEMESTER
____ SUMMER QUARTER
FOR THE FOLLOWING COURSE: COURSE NUMBER/TITLE ______________________________________CREDITS_________ WHICH WILL MEET THE URSULINE COLLEGE REQUIREMENT OF: _____________________________________________________________________________________ INDICATE COURSE NUMBER/TITLE IF A COURSE FOR MAJOR, OR INDICATE AS ELECTIVE CREDITS THIS STUDENT IS IN GOOD ACADEMIC STANDING (WITH G.P.A. 2.0 OR ABOVE) AT URSULINE COLLEGE.
APPROVED BY: ADVISOR___________________________________________ D ATE__________________ SCHOOL DEAN/OR OFFICE OF ACADEMIC AFFAIRS ___________________________________ (IF ATHLETE) FACULTY ATHLETICS REPRESENTATIVE (FAR) ___________________________________ UPON COMPLETION OF COURSE, THE STUDENT IS RESPONSIBLE FOR REQUESTING THAT A TRANSCRIPT BE SENT TO THE REGISTRAR’S OFFICE, URSULINE COLLEGE, 2550 LANDER RD., PEPPER PIKE, OH 44124. COURSES TAKEN AS A TR ANSIENT STUDENT WILL BE TRANSFERRED AS CREDIT HOURS EARNED O NLY: GRADES FROM TRANSFER CREDIT COURSES WILL NOT AFFECT THE STUDENT’S URSULINE COLLEGE GRADE POINT AVERAGE. THE OFFICE OF ACADEMIC AFFAIRS WILL DISTRIBUTE COPIES OF THIS FORM TO THE REGISTRAR, FINANCIAL AID OFFICE, ADVISOR, AND STUDENT.
*The Ursuline College Catalog states that in the semester before a student intends to graduate, she may not take courses away from Ursuline College. Approval to take a course off-campus does not constitute a waiver of this policy.
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TRANSIENT SUMMER EMAIL
November 9, 2015
RE: Taking a transient course during the summer 2015 term.
Dear Student Athlete, The Registrar’s Office has received your Transient Student Form for the summer 2015 term. It is your obligation to register for this course(s) at the college listed on the transient form. If you drop the course you should immediately notify the Registrar’s Office. Once you have completed the course, you need to have your official transcript mailed to Ursuline College. Have your official transcript mailed to: Ursuline College Admissions 2550 Lander Road Pepper Pike, Ohio 44124 If you have any questions, please do not hesitate to contact the Registrar’s Office.
Sincerely,
Leah Sullivan Registrar 440-646-8126
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Form 17-3e
Academic Year 2017-18
Drug-Testing Consent NCAA Division II For: Action: Due date: Required by: Purpose: Effective date:
Student-athletes. Sign and return to your director of athletics. At the time your intercollegiate squad first reports for practice or the first day of competition (whichever date occurs first). NCAA Constitution 3.3.4.10 and NCAA Bylaw 14.1.4.1 To assist in certifying eligibility. This consent form shall be in effect from the date this document is signed and shall remain in effect until a subsequent Drug Testing Consent Form is executed.
Requirement to Sign Drug-Testing Consent Form. Name of your institution: __________________________________________________________ Name of student-athlete: _____________________________________ Sport(s): ______________ You must sign this form to participate (i.e., practice or compete) in intercollegiate athletics per NCAA Constitution 3.3.4.10 and NCAA Bylaw 14.1.4.1. If you have any questions, you should discuss them with your director of athletics. Consent to Testing. You agree to allow the NCAA to test you on a year-round basis and in relation to any participation by you in any NCAA championship and in any postseason football game certified by the NCAA for the banned drugs listed in Bylaw 31.2.3 (attached). Examples of drugs under each class can be found at www.ncaa.org/drugtesting. Note: There is no complete list of banned substances. Check Drug Free Sport AXIS at 877-202-0769 or www.drugsfreesport.com/axis (Password: ncaa1, ncaa2, or ncaa3) for questions about supplements, medications and banned drugs.
Consequences for a Positive Drug Test. By signing this form, you affirm that you are aware of the NCAA drug-testing program, which provides:
1.
A student-athlete who tests positive for an NCAA banned drug must be immediately declared ineligible.
2.
A student-athlete who tests positive for a banned drug other than a “street drug” shall be withheld from competition in all sports for a minimum of 365 days from the drug-test collection date and shall lose a year of eligibility. A student-athlete who tests positive for a “street drug” shall be withheld from competition for 50 percent of a season in all sports (at least the first 50 percent of all contests or dates of competition in the season following the positive test);
3.
A student-athlete who tests positive has an opportunity to appeal the sanctions resulting from the positive drug test.
4.
A student-athlete who tests positive a second time for the use of any drug other than a “street drug” shall lose all remaining regular-season and postseason eligibility in all sports. A student93
Form 17-3e Page No. 2 _________ athlete who tests positive a second time for a street drug shall be withheld from competition for 365 days from the date of the test and shall lose an additional year of eligibility; 5.
The penalty for missing a scheduled drug test is the same as the penalty for testing positive for the use of a banned drug other than a street drug.
6.
A student-athlete found to have tampered with an NCAA drug-test sample shall be charged with the loss of a minimum of two seasons of competition in all sports and shall remain ineligible for all regular-season and postseason competition during the time period ending two calendar years (730 days) from the date of the test.
7.
If a student-athlete transfers to a non-NCAA institution while ineligible because of a positive NCAA drug test, and competes in collegiate competition within the prescribed penalty at a 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 the entirety of the prescribed penalty.
Signatures. By signing below, I consent: 1.
To be tested by the NCAA in accordance with NCAA drug-testing policy, which provides among other things that: a.
I will be notified of selection to be tested;
b.
I must appear for NCAA testing or be sanctioned for a positive drug test; and
c.
My urine sample collection will be observed by a person of my same gender;
2.
To accept the consequences of a positive drug test or a breach of drug testing protocol;
3.
To allow my drug-test sample to be used by the NCAA drug-testing laboratories for research purposes to improve drug-testing detection; and
4.
To allow disclosure of my drug-testing results only for purposes related to eligibility for participation in NCAA competition.
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Form 15-3e Page No. 3 _________
I understand that if I sign this statement falsely or erroneously, I violate NCAA legislation on ethical conduct, and will jeopardize my eligibility.
Date
Signature of student-athlete
Date
Signature of parent (if student-athlete is a minor)
Name (please print)
Date of birth
Age
Home address (street, city, state and zip code)
Sport(s)
What to do with this form: Sign and return it to your director of athletics at the time your intercollegiate squad first reports for practice or before the first date of competition (whichever date occurs first). This form is to be kept on file at the institution for six years.
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Form 17-3b
Academic Year 2017-18
Student-Athlete Statement NCAA Division II For: Action: Due date: Required by: Purpose: Effective Date:
Student-athletes. Sign and return to your director of athletics. Before you first compete each year. NCAA Constitution 3.3.4.9 and NCAA Bylaw 14.1.3. To assist in certifying eligibility. This NCAA Division II Student-Athlete Statement/DrugTesting Consent form shall be in effect from the date this document is signed and shall remain in effect until a subsequent NCAA Division II Student-Athlete Statement/Drug-Testing Consent form is executed.
Student-Athlete: (Please print name) Name of your institution:
Sport: This form has five parts: a statement concerning eligibility, a Buckley Amendment consent, results of drug tests, an affirmation of a valid ACT or SAT score and a statement concerning the amateur status of the student-athlete subsequent to the request of final certification by the NCAA Eligibility Center. If you are an incoming freshman you must sign parts I through V of this form to participate in intercollegiate competition. If you are a transfer or continuing student-athlete, you must sign parts I through IV. By signing this form, you affirm you have received and will read the Summary of NCAA Regulations, or another outline or summary of NCAA legislation, provided by your director of athletics, or read the bylaws of the NCAA Division II Manual that deal with your eligibility. You are responsible for knowing and understanding the application of all NCAA Division II bylaws related to your eligibility. If you have any questions, you should discuss them with your director of athletics, or you may contact the NCAA at 317/917-6222 or consult the NCAA website at www.ncaa.org. 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 II Manual: •
NCAA Constitution 3.3.4.9 and NCAA Bylaws 14.1.3, 14.1.3.2 and 18.4.1.5.7.
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Form 17-3b Page No. 2 _________
Part I: Statement Concerning Eligibility. You affirm that you have been provided and will read the Summary of NCAA Regulations, or another outline or summary of NCAA legislation, or the relevant sections of the Division II 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 have knowledge of and understand the application of NCAA Division II bylaws related to your eligibility. By signing this part of the form you affirm that, to the best of your knowledge, you have not violated any NCAA 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 2017-18 Drug-Testing Consent (Form No. 17-3e). You affirm that you will report 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 further will jeopardize your eligibility.
Name of student-athlete (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)
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Form 17-3b Page No. 3 _________
Part II: Buckley Amendment Consent. By signing this part of the form you certify that you agree to disclose your education records. You understand that this entire form and the results of any NCAA drug test you may take are part of your education 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: 1.
This form;
2.
Results of NCAA drug tests and related information and correspondence;
3.
Results of positive drug tests administered by a non-NCAA national or international sports governing body;
4.
Any transcript from your high school, this institution or any junior college or other fouryear institution you have attended;
5.
Precollege test scores, appropriately related information and correspondence (e.g., testing sites, dates and letters of test-score certification or appeal) and, where applicable, information relating to eligibility for or conduct of nonstandard testing;
6.
Graduation status;
7.
Race and gender identification;
8.
Diagnosis of any education-impacting disabilities;
9.
Accommodations provided or approved and other information related to any educationimpacting disabilities in all secondary and postsecondary schools;
10.
Records concerning your financial aid; and
11.
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 academic success, for awards and recognition programs highlighting student-athlete academic 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
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Form 17-3b Page No. 4 _________ 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 studentathlete reinstatement case, infractions case or waiver request or to recognize your selection for an academic award (e.g., Elite 89). 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 of student-athlete (please print) Signature of student-athlete
Date
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Form 17-3b Page No. 5 _________
Part III: Results of Drug Tests. 1. Future positive test – all student-athletes sign. Should I test positive for a substance banned by the NCAA and/or by a sports governing body that has adopted the World Anti-Doping Agency (WADA) code, or violate a drug-testing protocol or fail to show for a drug test at any time after I sign this statement, I acknowledge I must report the results to my director of athletics.
Name of student-athlete (please print)
Date
Signature of student-athlete 2. Positive test by NCAA or other sports governing body -- sign either A or B. A.
No positive drug test. I affirm that I have never tested positive for a substance banned by the NCAA and/or a sports governing body that has adopted the WADA code, nor violated a drug-testing protocol or failed to show for a drug test conducted by the NCAA or a sports governing body. ____________________________________________________ Name of student-athlete (please print) _________________________________ _______________ Signature of student-athlete Date
B.
Positive drug test. I have tested positive for a substance banned by the NCAA and/or by a sports governing body that has adopted the WADA code, or have violated a drug-testing protocol or failed to show for a drug test conducted by the NCAA or a sports governing body. If I transfer to another institution, I am also obligated to report this information to that institution. Name Signature Date of test
Organization conducting test
Substance
Are you currently under such a drug-testing suspension? Yes ____ No ____ 100
Form 17-3b Page No. 6 _________ Part IV: Affirmation of Status as an Amateur Athlete. You affirm that you have read and understand the NCAA amateurism rules. By signing this part of the form you affirm that, to the best of your knowledge, you have not violated any amateurism rules since you requested a final certification from the Eligibility Center or since the last time that you signed a Division II student-athlete statement, whichever occurred later. You affirm that since requesting a final certification from the Eligibility Center, you have not provided false or misleading information concerning your amateurism status to the NCAA, the Eligibility Center and the institution's athletics department, including administrative personnel and the coaching staff. Name of student-athlete (please print)
Date
Signature of student-athlete
Part VI: Incoming Freshmen – Affirmation of Valid ACT or SAT Score. You affirm that, to the best of your knowledge, you have received a validated ACT and/or SAT score. You agree that, in the event you are or have been notified by ACT or SAT of the possibility of an invalidated test score, you immediately will notify the director of athletics of your institution. Name of student-athlete (please print)
Date
Signature of student-athlete ______________________________________________________________________________ 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 director of athletics or you may contact the NCAA at 317/917-6222.
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Student-Athlete Authorization/Consent for Disclosure of Protected Health Information for NCAA-Related Research Purposes
I, ____________________________ hereby authorize ___________________________________ Name of Student-Athlete Name of my Institution and its physicians, athletic trainers and health care personnel to disclose my protected health information including, without limitation, any information regarding any injury, illness, treatment or participation related to or affecting my training for and participation in intercollegiate athletics to the National Collegiate Athletic Association (NCAA), and its designated employees, agents and/or contractors. I further authorize the NCAA to disclose, and/or use, such information as provided herein. I understand that my participation and protected health information may be disclosed to, and/or used by, the NCAA, and authorized third parties to receive such information for the purpose of using injury, relevant illness and participation information collected from multiple student-athletes and institutions in a manner that does not identify myself or my school. The information is provided to NCAA committees, athletics conferences and individual schools, and NCAA-approved researchers to evaluate the effectiveness of health and safety rules and policy, and to study other sports medicine questions. Selected de-identified summary (aggregate) data also are made accessible to the general public as a service to further the general understanding of athletic injury patterns and help develop education on student-athlete health topics. I am making this authorization/consent voluntarily to release my health information otherwise protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment). The NCAA and institution are not requiring this authorization/consent to be signed. I understand that while HIPAA regulations may not apply to NCAA use or disclosure of my injury/illness information, the NCAA is committed to protecting my privacy. I understand that my data will be stored securely within industry standards. This authorization/consent for transfer of protected health information expires 545 days from the date of my signature below, but I have the right to revoke it in writing at any time by sending written notification to the director of athletics at my institution. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date.
Printed Name of Student-Athlete
Signature of parent or legal guardian (if Student-athlete is a minor)
___________________________________ Signature Date _______________ Date
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G-MAC Sportsmanship Statement The Presidents, Faculty Athletic Representatives, Athletics Directors, Senior Woman Administrators and coaches in the conference are committed to maintaining sportsmanship and healthy competitive environments. The G-MAC will strive to promote environments that are hospitable; the conference does not believe that it is desirable to create a hostile environment for intercollegiate athletic contests. The members believe that part of the mission of intercollegiate athletic programs, within an educational context, should be to set an example for students and communities of how to act with sportsmanship and respect for opponents. Therefore, the G-MAC expects all participants to treat opponents and officials with respect. Failure to do so may lead to penalties. Trash talking, taunting, baiting, celebrations that demean opponents, vulgar or profane language, intimidating actions, fighting, attempts to injure, and any other malicious or violent conduct may be penalized by contest officials and /or the conference. G-MAC Student-Athlete Pledge of Sportsmanship As a Great Midwest Athletic Conference student-athlete, I understand that the use of inappropriate language, taunting, baiting or the use of unwarranted physical contact, directed at opposing players, coaches, or fans are contrary to the spirit of fair play and the sportsmanship the conference expects of its members. I understand that any unsportsmanlike action during the course of the contest may result in an immediate penalty assessed to me or my team. Furthermore, I understand that game officials have been instructed that they may assess such penalties without prior warning. In signing this form, I pledge my efforts to promote G-MAC sportsmanship policies. _________________________________________________________________ Print Name _________________________________________________________________ Signature _________________________________________________________________ Date
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URSULINE COLLEGE PROMOTIONAL AUTHORIZATION In accordance with NCAA Bylaw 12.5.1.1, I give my permission to authorized representatives of Ursuline College to use my name, picture, identity, appearance and personal academic (e.g., cumulative GPA, academic major) and athletic (e.g., batting average, points, yards) statistics for institutional and community promotional activities. Promotional activities include but are not limited to game promotional activities, ticket sales, press releases, information provided for articles and stories by outside media entities, fundraisers, posters, schedule cards, calendars, institutional charitable or community activities, booster functions, and institutional marketing (e.g., admissions). All monies derived from such promotions are required to be provided directly to Ursuline College.
Academic Year: Student Name (Print First & Last):
Student Signature:
Date:
*Note: If a student is under the age of 18, please ensure the signature of the parent/guardian is on file.
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Great Midwest Athletic Conference Request for Medical Hardship Waiver Submitting Institution: _________________________________
Sport: ___________________________________________
Name of Student-Athlete: _______________________________
Academic Year of Waiver Request: ___________________ (Year the injury/illness occurred)
All hardship waiver requests must comply with NCAA Bylaw 14.2.5 and G-MAC policies
Participation Information 1. Did the Student-Athlete’s injury or illness occur in one of the four seasons of intercollegiate athletic competition? Yes No Institution where injury or illness occurred: ___________________________________ 2. Date of injury or illness: ____________________________ 3. Did the injury or illness occur prior to the Student-Athlete’s participation in (1) more than two contests or dates of competition; (2) 20% of the institution’s completed contests or dates of competition; or (3) 20% of the maximum permissible number of contest of dates of competition as set forth in Bylaw 17 in his/her sport?
Yes No *Note: Only competition against outside participants during traditional playing season shall be counted. Scrimmages and exhibition against outside competition shall NOT be counted. 4. The Student-Athlete participated in _______ contests/dates of competition during the championship segment. 5. Description of injury/illness: _____________________________________________________________________
The following items MUST be attached to this form at the time of submission: 1. 2. 2. 3. B.
A complete copy of the institution’s published schedule with clear identification of regular season contests. Individual performance statistics for the Student-Athlete requesting the hardship waiver. A signed Buckley Statement from the Student-Athlete requesting the hardship waiver. Contemporaneous medical documentation from a medical doctor that includes the following: Validation of the timing of the injury or illness – required; C. 1. Contemporaneous letter or diagnosis from treating physician identifying injury/illness as “incapacitating” OR Noncontemporaneous letter or diagnosis from treating physician identifying injury/illness as “incapacitating” AND 2. Treatment logs or athletic trainer’s room notes (indicating continuing rehabilitating efforts); (C) 1. Estimated length of incapacitation or recovery time range contained within original contemporaneous medical documentation AND 2. Contemporaneous documentation of follow-up doctor’s visits (within the estimated time range) in which the student-athlete cleared to resume playing OR Treatment logs or athletic trainer’s room notes (indicating continuing rehabilitation efforts). I hereby certify that to the best of my knowledge, the above & attached information is accurate & complete.
Director or Athletics Signature: ______________________________________ Date: ___________________ Student-Athlete Signature: __________________________________________ Date: ___________________ Compliance Coordinator Signature: ___________________________________ Date: ___________________ CONFERENCE USE ONLY – To be completed by Commissioner or Designee Request Approved
Request Denied
Signature: _____________________________ Date: ____________
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Grant-In-Aid Request Form (GIAR)
(Please PRINT clearly)
This form is required to be completed for all initial athletic awards and also any increases, reductions or cancellations to athletic scholarships. Renewals will be submitted via summary lists each Spring. Instructions: Head Coaches should submit this form to the Athletic Director for approval. If approved, the form should be given to the Compliance Coordinator to review, create and send the official Athletic Scholarship Letter/NLI. Once the scholarship letter is prepared, the department secretary should forward copies of this form and the official offer letter to the Compliance Coordinator and Director of Financial Aid. Academic Year: ____________________________ Date: __________________
Letter(s):
Sport: _______________________________________
UC Scholarship only NLI & UC Scholarship
NCAA Eligibility Center ID #: _______________________
Ursuline Acceptance Date: _______________________
Student Name:
Email: ______________________________________
__________________________________
Compliance email the letter & info Address:
Fwd to coach for coach to email the letter & info
______________________________________________________________________________ ______________________________________________________________________________
Period of Award:
Academic Year
Spring Semester Only
Type of Award:
Initial Award
Increase
Athletic Award Amount:
Fall Semester Only
Reduction
Cancellation
Flat Athletic Dollar Amount $____________________ Full Tuition – Up to ___________ credit hours per year Full Grant-In-Aid (including Room & Board) – Up to ___________ credit hours per year
For either full award:
Do not include any fees Include course fees Include tech fees Include parking fees
List any other UC awards, in addition to the above athletic scholarship, you believe to be included in the aid package: ____________________________________________________________________________________ Award amounts are distributed equally (dependent on credit hours taken) between Fall and Spring Semesters. Room & Board dollars can only be applied to Ursuline College residence hall fees. Books are currently not included in athletic scholarships.
NOTES : ____________________________________________________________________________________
______________________________________ Head Coach Signature
______________________________________ Athletic Director Signature
_________________ Date
_________________ Date
Date copies forwarded to the Compliance Coordinator and Financial Aid Director: ______________
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May 9th, 2015
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109
110
111
112
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PROSPECT NAME:
SPORT:
ACCOMPANIED BY:
ARRIVAL DATE:
[NAME(S)] RELATIONSHIP:
DEPARTURE DATE:
[ EX: FATHER ]
NAM SCHOOL:
GRADUATION YEAR:
CURRENT STATUS:
HS SR HS JR HS SOPH HS FR 2-YEAR 4-YEAR
ENTERTAINMENT During an unofficial visit, the College may not pay any expenses or provide any entertainment except complimentary admissions (maximum of 3) to a campus athletics event in which the institution’s intercollegiate team practices or competes. Were complimentary admissions given to this prospect? Yes (Contest:_____________________) No MEALS All DII institutions may provide a prospect and the prospect’s parents or legal guardians with one (1) meal during an unofficial visit to campus. New legislation permits this meal to be on or off-campus, granted it is in the locale of the College (no more than 30 miles).
Yes
Were prospect and/or parents provided a meal? If Yes, please select :
No
Breakfast Lunch Dinner
Where was the meal located? How was the meal paid for? TRANSPORTATION During an unofficial visit, the College may provide the prospect with transportation only to view off-campus practice and competition sites in the prospect’s sport and other institutional facilities (located within a 30-mile radius of campus). An institutional staff member must accompany the prospect during such a trip. Payment of other transportation expenses shall cause the trip to become an official paid visit. Was prospect provided transportation during the unofficial visit? If yes, please describe the transportation
Yes No
and list driver
.
LODGING At this time Ursuline College does not charge students to have guests stay overnight in their dorm rooms. Payment of any other lodging expenses shall cause the trip to become an official paid visit. Did prospect stay in a residence hall with a current student-athlete? If No, did the prospect or her parent/guardian pay for their lodging? Coach Signature
Yes No N/A Yes No Date
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SPORT:
TRYOUT DATE:
PROSPECT/STUDENT NAME:
DATE OF BIRTH:
EMAIL:
PHONE:
ADDRESS: Does this student currently attend Ursuline College? No Yes Was this individual ever recruited by Ursuline College? No Yes
(If yes and a current Ursuline student, a tryout is NOT permitted.)
TRYOUT REGULATIONS:
All tryouts must occur at Ursuline College’s regular practice or competition facilities. No more than one (1) tryout per student (prospective or currently enrolled) per sport is permitted. All high school prospects must have either exhausted eligibility in the sport or be outside of their sport season (not in the time from the first practice through the final contest). Transfer prospects must have concluded their sport season or can be conducted anytime if they have exhausted their eligibility (2-year prospects). Equipment and clothing may be provided for tryout activities, but only on an issuance-and-retrieval basis. No tryout can last longer than two (2) hours. Prior to participation in any activities, documentation must be provided showing a medical exam has been given within six (6) months prior to the tryout. The examination or evaluation shall include a sickle cell solubility test (SST), unless documented results of a prior test are provided to Ursuline or the prospective student-athlete declines the test and signs a written release. See instructions below for further details.
HIGH SCHOOL ATTENDANCE Name of School:
Graduation Date:
Sports Played: ________________________________________ Has the individual exhausted eligibility in this sport? If no, practice start date: ____________________
No Yes
Date of last competition: ____________________
COLLEGE ATTENDANCE Name of Institution
2yr / 4yr
Dates Attended
FT/PT
Sports Played: ________________________________________ Has the individual exhausted eligibility in this sport? If no, practice start date: ____________________
Graduated ?
No Yes
Date of last competition: ____________________
INSTRUCTIONS All individuals (and parent/guardian if a minor) need to complete and sign a Prospective Student-Athlete Liability Release Waiver prior to participation in any Tryout activities. All documentation must be given to the Compliance Coordinator for approval before any tryout activities may occur. For prospective studentathletes this must be done no later than 1 business day before the proposed tryout. For current Ursuline students this must be done no later than 1 week prior to the proposed tryout.
APPROVAL Compliance Coordinator (or AD in absence) Signature:
Date: 115
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INSTITUTIONAL CAMP/CLINIC FORM COACH:
SPORT:
CAMP NAME:
CAMP ADMINISTRATOR: (IF OTHER THAN COACH):
PLEASE COMPLETE ALL OF THE FOLLOWING ABOUT THIS CAMP/CLINIC: Proposed Dates of Camp/Clinic: Location of Camp/Clinic: Facilities Utilized for Camp/Clinic: Purpose of Camp/Clinic: Housing for Campers: Housing for Employees: Camp Fee: Is this camp/clinic restricted or limited in any manner regarding campers (i.e. age, class, # campers)? If yes, please list how:
Yes No
Will the campers receive any items or awards as part of their camp payment (i.e. t-shirt, bag, trophy)? If yes, please list items/possible awards:
Yes No
List all methods of advertisement or solicitation for this camp/clinic (i.e. brochure, email, ads). Attach copies of each. All brochures or advertisements must be approved by Compliance Coordinator prior to printing and disbursement.
Do you have any partnerships or agreements with any individuals, organizations or companies outside of Ursuline College? If yes, please list name and relationship/camp function below: Yes No
Will any free/reduced admissions be available to campers? (If yes, check type below & attach list of all recipients for each) Yes No (All discounts must be published & provided to all individuals in given category, otherwise they are not permissible)
Child of coach/administrator working the camp/clinic Child of Ursuline College faculty/staff Group rate Early or online registration Other (specify, approval required prior to use) 117
EMPLOYMENT: COACHES/ADMINISTRATORS NCAA member schools are permitted to employ high school, prep school or two-year college coaches provided:
Compensation is at the going rate for similar ability or experience Compensation is not on the basis of the coach’s reputation or contact with prospects Compensation is not based on the number of campers a coach sends to the camp/clinic
STUDENT-ATHLETES NCAA member schools are permitted to employ college student-athletes (including our own) provided:
Duties are of a general supervisory nature in addition to coaching or officiating Compensation is at the going rate for teaching ability or camp experience, and not based on athletics reputation or athletics skill level No organized practice activities take place during or in conjunction with the camp/clinic
SUMMARY: As specified within this document, please attach the following with this form and submit to the Compliance Coordinator no later than one month prior to the camp/clinic:
Any brochures or advertisements for this camp/clinic (prior approval required prior to printing & distributing). List of any free or reduced admission offered, including all campers that fall within that category. List of all coaches and administrators employed by the camp/clinic (including name, school affiliation, position, compensation and
List of all student-athletes employed at this camp/clinic (including name, sport team, duties and compensation).
experience).
PRIOR to the start of any camp/clinic activities the coach must have on file a completed and signed Liability Release Waiver-ALL Minors for every camper. Waiver forms can be found under the Compliance folder on the Athletics “M” drive.
At the conclusion of the camp/clinic the coach is responsible for submitting the following to the Compliance Coordinator:
Either copies or originals of all waiver forms for campers. Records or ledgers of camp expenses and camper payments.
I am aware of all NCAA rules (NCAA Bylaw 13.12) regarding camps and clinics and confirm that the above information is true and accurate, and that all attendance and employment of this camp complies with the rules and regulations of the NCAA to the best of my knowledge. Subsequent to this date, I will notify the Compliance coordinator of any potential problems or violations that may arise regarding this camp/clinic.
Head Coach
Date
Compliance Coordinator or Athletic Director Signature
Date
118
119
OUTSIDE CAMP/CLINIC APPROVAL FORM COACH or STUDENT-ATHLETE: Please submit the following information to the Compliance Coordinator, or Athletic Director in his/her absence at least two weeks prior to working the camp/clinic. NAME:
SPORT:
NAME OF CAMP/CLINIC:
Private Institutional (if so, name of school): LOCATION: NAME OF CAMP/CLINIC DIRECTOR: DIRECTOR ‘S EMAIL: DIRECTOR
PHONE:
CAMP/CLINIC DATES: WORK TO BE PERFORMED: SALARY:
Yes No
Is this camp/clinic restricted or limited in any manner regarding campers (i.e. age, class, # campers)? If yes, please list how:
TRAVEL ARRANGEMENTS: Yes No Yes No
Camp/clinic is paying for travel to/from site If camp/clinic is paying for transportation; this is the policy for all camp employees
I understand the NCAA rules (Bylaw 13.12) regarding outside camps and clinics, including the following statements:
If a coach, I understand that athletics department personnel may serve in any capacity at a privately owned camp or clinic provided it’s operated in accordance with all NCAA rules: Open to general public (except for restrictions in age or number of participants), No free/reduce admission to prospects, Conducted primarily for educational purposes & fundamentals skills & does not include material benefits, Participants do not receive a recruiting presentation, All participants reside within 100 miles of the camp/clinic.
If a coach, I understand that I may not be employed (salaried or volunteer) in any capacity by a camp or clinic that provides recruiting or scouting services. If a student-athlete, I understand that I must perform duties that are of a general supervisory nature in addition to any coaching or officiating assignments. If a student-athlete, I understand that I must be paid the same as other employees with similar camp/clinic ability or experience, and if I only lecture or demonstrate I may not receive compensation.
Approved Denied
If denied, rationale:
Coach or Student-Athlete Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
120
STUDENT-ATHLETE EMPLOYMENT FORM Student-Athlete Name:
Date:
Sport(s): Local Address: Permanent Address: Employer Name: Employer Address: Contact/Supervisor:
Phone:
Position(s): Description of Duties:
Rate of Pay: $ Dates of Employment:
/Hour
$
/Week
$
From:
Did anyone connected with Ursuline Athletics help you get this job?
/Month
$
/Project
Full-time Part-time
To: Yes No
If Yes, who was it & how did they help?
Student-Athlete (Signature)
Date:
121
2017-2018 FEDERAL WORK STUDY CERTIFICATION AND APPLICATION The below student has qualified for employment under the Federal Work Study Program for the 2011/2012 school year. The awarded amount is the maximum amount the student may earn during the 2010/2011 school year.
NAME:
AWARD AMOUNT: $
Students who wish to work on campus or those who wish to work off campus for the America Reads Program must complete this form. If this is your first time being employed at Ursuline College; you must also submit the appropriate tax forms (I-9, W-4, and Ohio withholding form).
TO BE COMPLETED BY STUDENT: NAME ____________________________________________
STUDENT ID _____________________________
ADDRESS _________________________________________
CITY, STATE, ZIP ________________________
PHONE NUMBER ___________________ Please list your previous work experience, including company’s name, dates of employment, and basic responsibilities: 1) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 2) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 3) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Please list any additional qualifications and skills: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Days Available for work:
Monday______ Tuesday______ Wednesday______ Thursday______ Friday______
Saturday______ Sunday______
STUDENT SIGNATURE _______________________________________
To be completed by employer Student’s Job Title _____________________________________________ Department _____________________________________
Hourly Pay rate __________________
Date of Hire ______________________
Employer Name (printed) _______________________________________________ Employer Signature ___________________________________________________
122
SPORT:
ACADEMIC YEAR:
HEAD COACH:
DATE:
In accordance with NCAA Bylaw 17.1.3, I hereby declare my playing season as follows: Number of Contests (Max __, Min__): Number of Scrimmages (up to __): Number of Exemptions (Please specify below):
CHAMPIONSHIP SEGMENT First Permissible Practice Date: First Actual Practice Date: First Permissible Competition Date: First Actual Competition Date: Last Competition Date:
NON- CHAMPIONSHIP SEGMENT First Permissible Start Date: First Actual Practice Date: Last Permissible End Date: Actual End Date Date:
PLEASE ENCLOSE WITH THIS DOCUMENT: A schedule of all contests for the academic year A roster of all team members (as of this date) with freshman and new transfers indicated
Head Coach Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
123
SPORT:
ACADEMIC YEAR:
HEAD COACH:
DATE:
In accordance with NCAA Bylaw 17.1.3, I hereby declare my playing season as follows below: Dates of Competition ( ______ max): Number of Contests ( ______ min): Number of Scrimmages: Number of Exemptions (Please specify below):
Total Days Permitted in Playing Season ( _____ ):
CHAMPIONSHIP SEGMENT 1 Days Used in Segment 1: First Permissible Practice Date: First Actual Practice Date: First Permissible Competition Date: First Actual Competition Date: Last Competition Date:
CHAMPIONSHIP SEGMENT 2 Days used in Segment 2: First Permissible Start Date: First Actual Start Date: Last Permissible End Date: Actual End Date:
PLEASE ENCLOSE WITH THIS DOCUMENT: A schedule of all contests for the academic year A roster of all team members (as of this date) with freshman and new transfers indicated Head Coach Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
124
2017-18 CARA FORM PLAYING & PRACTICE SEASONS – DAILY & WEEKLY HOUR LIMITATIONS Per NCAA regulations, each intercollegiate sport program must record on a daily basis any countable athletically related activity. All activities must count against the following NCAA limits: IN-SEASON = = four (4) hours/ day, twenty (20) hours/week with one (1) day off per week OUT-OF-SEASON = eight (8) hours/week [2 of the 8 hours can be individual skill instruction] with (2) days off per week
SPORT:
WEEK of SUNDAY
to SATURDAY
*REMINDER – Competition always counts as 3 hours regardless of how long it lasts*
Sunday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Monday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Tuesday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Wednesday
Thursday
Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Friday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Saturday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
WEEK’S TOTAL Sum of all day’s totals for the week below.
Any individual exceptions to above team activities can be recorded below…
STUDENT-ATHLETE NAME
DAY/DATE
ACTIVITY/HOURS
STUDENT-ATHLETE NAME
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
COACH’S SIGNATURE
DATE
SAAC MEMBER SIGNATURE
DATE
DAY/DATE
ACTIVITY/HOURS
COMPLIANCE COORDINATOR’S SIGNATURE
DATE
Forms to be submitted to the Compliance Coordinator on the Monday following the week above
125
2011-12 Competition Record
Instructions 1
Basketball
2
Date - First Contest (including scrimmages/exhibitions) :
3
Date - Last Regular Season Contest: Date - Final Post-Season Competition:
4
Head Coach:
5
Captain (s):
6 7 8 9 10
No Competition M=Medical C = Cut Q = Quit
On or After Comp Start Date
O = Other
Y=Yes
N=No
Class Year
◄Provide the information requested on the left side of the page. Student-Athlete List. This list is to include the names of all student-athletes who were on the squad on the date of the first practice of the academic year, as well as those of any student-athlete who joined the team after the first practice. Any missing names are to be typed in at the bottom of the list. Record Name of Opponent or Event and Date of Competition. List contests in chronological order with the name of the opponent or event above the date. Every contest in which a squad member represents Ursuline is to be listed (including scrimmages and exhibitions). Use one column for each day of competition. Record Student-Athlete's Participation in Competition. Place the number "1" in the corresponding contest column for all competitions in which a squad member has participated. Student-Athlete did not participate in any outside competition. Record reason for non-participation in the No Competition column [M=Medical, C=Cut/Dismissed, P= Practice Only, Q=Quit]. Indicate "Y" if reason for no competition occurred on or after date of first countable competition or "N" if reason occurred before date of first countable competition. Record Letter Winner indicator of "Y". In the Letter Winner column, indicate those squad members who satisfy the criteria for a varsity letter. Position column is to be completed by the following field sport programs ONLY - lacrosse, soccer and softball. Total Team Competitions column is for Compliance Office use only. Please do not record any data in this column. Submitter's Name and date of submission. The name of coach completing this report and the date of submission are to be typed into the spaces indicated Completed Competition Record is to be submitted electronically (email attachment) not later than 7 days following the last regular season date of competition. Submit to the Compliance Coordinator at [email protected] Retain a copy for your files.
Letter Student-Athlete
Winner
Position
Carlow
UM Dearborn
Roberts
Houghton
Lake Erie
LaRoche
Marietta
Notre Dame
Cedarv ille
Wooster
Oberlin
Total Team
6-Nov
10-Nov
12-Nov
13-Nov
15-Nov
20-Nov
23-Nov
30-Nov
4-Dec
8-Dec
10-Dec
Competitions
1 1
1 1
1
1 1
1 1
1 1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
11 8 10 11 3 7 11 11 9 11 11 10
Scrim
Scrim
1 1
1 1
1
1
2012
Y Y
3
2013
Y
1
1
1
1
4
2009
Y
1
1
1
1
5 6
2013 2010
Y
1 1
1 1
1
1
1
1
1
7
2012
Y
1
1
1
1
1
1
1
1
1
1
1
8
2012
Y
1
1
1
1
1
1
1
1
1
1
1
9 10
2013 2011
Y
1 1
1 1
1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
11
2010
Y
1
1
1
1
1
1
1
1
1
1
1
12
2011
Y
1
1
1
1
1
1
1
1
1
1 2
2011
Jane Doe
1
1
1
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Name of Coach Submitting completed Competition Record: Date:
126
Participation in outside competitions and on outside teams, while a member of an intercollegiate team at Ursuline College, can jeopardize a student-athlete’s eligibility. Prior written approval is required for any Ursuline College student-athlete to participate in any form of outside competition either during the academic year or summer. The following form must be filled out completely, signed and turned in to the Compliance Coordinator for approval no later than two weeks prior to any outside competition. STUDENT-ATHLETE NAME:
SPORT:
CELL PHONE:
E-MAIL:
APPROVAL TO:
Compete Unattached
Represent Institution
Represent Outside Team
DATE(S):
NAME OF OUTSIDE TEAM: EVENT NAME:
LOCATION:
TYPE OF EVENT: Please check below…
High School Alumnae/Alumni Game
Summer League
Officially Recognized State or National Multisport Event
Pan American Games Tryout or Competition
Olympic Games or Qualifier
US National Team
World or World Youth Championships, World University Games or World Cup Tryouts or Competition Other (Please describe): ____________________________________________________________________________ Are any expenses (transportation, lodging, meals, apparel, equipment, entry fees) being paid by anyone other than you or your parents or legal guardians? No Yes If Yes, by whom & what expenses:_______________________________________________________________________________ Will any class time be missed for these activities? _________________________________ Student-Athlete Signature
No
______________ Date
Yes
(If Yes, prior approval from professors is required)
_________________________________ Head Coach Signature
______________ Date
Compliance Office Use Only
Approved
Denied
REASON FOR DENIAL:
SIGNATURE OF COMPLIANCE COORDINATOR:
DATE:
127
i
Letters of Admonishment & Reprimand ................................................................................................. 14 SPORTSMANSHIP & ETHICAL CONDUCT ..................................................................................................... 15 Unethical Conduct................................................................................................................................... 15 Gambling & Sports Wagering.................................................................................................................. 16 DRUGS & ALCOHOL ..................................................................................................................................... 17 Athletic Department Drug & Alcohol Policy ........................................................................................... 17 NCAA Drug Testing Policy ....................................................................................................................... 22 Medical Exceptions & Supplements........................................................................................................ 23 NCAA Banned Drug Classes..................................................................................................................... 24 NCAA TOBACCO POLICY .............................................................................................................................. 24 PERSONNEL ................................................................................................................................................. 25 Assistant, Graduate, Volunteer and Contractual Coaches or Personnel ................................................ 25 Athletically-Related Outside Income ...................................................................................................... 25 Eligibility Lists & Roster Procedures........................................................................................................ 26 ADMISSION ................................................................................................................................................. 28 First-Year Students .................................................................................................................................. 28 Transfers ................................................................................................................................................. 28 International Students ............................................................................................................................ 29 INITIAL ELIGIBILITY ...................................................................................................................................... 30 NCAA Eligibility Center ............................................................................................................................ 30 Academic Certification ............................................................................................................................ 30 Amateurism Certification ........................................................................................................................ 31 TRANSFERS .................................................................................................................................................. 32 Permission To Contact ............................................................................................................................ 32 Other Institution’s Student-Athletes .................................................................................................. 32 Ursuline College Student-Athletes ...................................................................................................... 32 Transfer Appeal Process...................................................................................................................... 33 Transfer Eligibility.................................................................................................................................... 35 CONTINUING ELIGIBILITY ............................................................................................................................ 36 Full-Time Standing .................................................................................................................................. 36 9 Hour Rule ............................................................................................................................................. 37 24 Hour Rule ........................................................................................................................................... 37
ii
Regular Academic Year Hours/18 Hour Rule .......................................................................................... 38 Good Academic Standing & GPA (Grade-Point-Average) ....................................................................... 38 Ursuline Academic Standing & Incomplete Grade Policy ................................................................... 39 Designation of Degree Program.............................................................................................................. 39 Progress-Toward-Degree ........................................................................................................................ 40 Exceptions To Progress-Toward-Degree ................................................................................................. 40 SUMMER SESSION PROCEDURES ............................................................................................................ 41 Summer at Another Institution ........................................................................................................... 41 Summer at Ursuline ............................................................................................................................ 41 STUDENT-ATHLETE ACADEMIC PROBATION POLICY .............................................................................. 42 OTHER ELIGIBILITY REQUIREMENTS ....................................................................................................... 44 ELIGIBILITY TIMELINE .............................................................................................................................. 45 SEASONS OF COMPETITION .................................................................................................................... 47 HARDSHIP WAIVERS................................................................................................................................ 47 STUDENT-ATHLETE ACADEMIC RESPONSIBILITY ........................................................................................ 50 Missed Class Policy.................................................................................................................................. 50 FINANCIAL AID PROCEDURES...................................................................................................................... 51 Procedures for Prospective Student-Athlete Package Estimates ........................................................... 51 Procedures for Initial Grant-In-Aid to Prospective Student-Athletes ..................................................... 51 Procedures for Changes to Grant-In-Aid During an Award Period ......................................................... 53 Procedures for Renewal of Grant-In-Aid to Returning Student-Athletes ............................................... 54 Procedures for Reduction/Non-Renewal for Returning Student-Athletes ............................................. 54 Appeals Procedure: Reduction, Non-Renewal, Cancellation .................................................................. 55 Procedures for Non-Institutional Outside Financial Aid ......................................................................... 56 RECRUITING ................................................................................................................................................ 57 Coaches Certification Test ...................................................................................................................... 57 Documentation ....................................................................................................................................... 58 Official “Paid” Visits ................................................................................................................................ 58 Student-Athlete Hosts............................................................................................................................. 59 Unofficial Visits ....................................................................................................................................... 60 TRYOUTS ..................................................................................................................................................... 61 Prospective Student-Athletes ................................................................................................................. 61
iii
Enrolled Students/Walk-Ons................................................................................................................... 61 AWARDS & BENEFITS .................................................................................................................................. 63 Extra Benefits .......................................................................................................................................... 63 Complimentary Admissions .................................................................................................................... 63 Student-Athlete Awards ......................................................................................................................... 64 Varsity Awards ........................................................................................................................................ 64 Multisport Student-Athletes ................................................................................................................... 65 Occasional Meals .................................................................................................................................... 65 CAMPS & CLINICS ........................................................................................................................................ 66 Institutional Camps & Clinics .................................................................................................................. 66 Outside Camps & Clinics ......................................................................................................................... 67 STUDENT-ATHLETE EMPLOYMENT ............................................................................................................. 68 Off-Campus Employment........................................................................................................................ 68 On-Campus Employment ........................................................................................................................ 68 Academic Year Procedures: ................................................................................................................ 68 Summer Session Procedures:.............................................................................................................. 68 PLAYING & PRACTICE SEASONS .................................................................................................................. 69 Playing Season Declarations ................................................................................................................... 69 Daily/Weekly Hour Limitations & Logs ................................................................................................... 69 Countable Athletically Related Activities ................................................................................................ 71 Voluntary Athletically Related Activities................................................................................................. 72 Competition Records .............................................................................................................................. 72 OUTSIDE COMPETITION .............................................................................................................................. 73 All Sports Other Than Basketball ............................................................................................................ 73 Basketball ................................................................................................................................................ 73 Procedures For All Outside Competition Approval ................................................................................. 73 Appendix 1 - Booster Education ................................................................................................................. 74 Appendix 2 – Drug Testing Consent & Release of Information Form ......................................................... 75 Appendix 3 – Suspicion Based Testing Form............................................................................................... 76 Appendix 4 – Volunteer/Independent Contractor Athletic Personnel Agreement .................................... 77 Appendix 5 – Outside Coaching Approval Form ......................................................................................... 79 Appendix 6 – Athletically-Related Outside Income Form ........................................................................... 80
iv
Appendix 7 – Permission Request – Other Schools .................................................................................... 81 Appendix 8 – Permission to Contact-Release Request Form...................................................................... 82 Appendix 9 – Permission Letter – Ursuline Student ................................................................................... 83 Appendix 10 – Eligibility Tracer – Release Form ......................................................................................... 84 Appendix 11 – Transfer Student-Athlete Eligibility Evaluation Form ......................................................... 85 Appendix 12 – Historical Questionnaire ..................................................................................................... 86 Appendix 13 – Registration Form ............................................................................................................... 88 Appendix 14 – Course Change Form ........................................................................................................... 89 Appendix 15 – Change of Major Form ........................................................................................................ 90 Appendix 16 – Transient Student Form ...................................................................................................... 91 Appendix 17 – Transient Summer Email ..................................................................................................... 92 Appendix 18 – NCAA Drug Testing Consent Form ...................................................................................... 93 Appendix 19 – NCAA Student-Athlete Statement ...................................................................................... 96 Appendix 20 – NCAA HIPAA Form ............................................................................................................. 102 Appendix 21 – G-MAC Sportsmanship Form ............................................................................................ 103 Appendix 22 – Ursuline Promotional Authorization Form ....................................................................... 104 Appendix 23 – G-MAC Medical Hardship Form ........................................................................................ 105 Appendix 24 – Grant-In-Aid Request Form ............................................................................................... 106 Appendix 25 – Athletic Scholarship Letter ................................................................................................ 107 Appendix 26 – Returning Student-Athlete Scholarship Letter.................................................................. 108 Appendix 27 – Official Visit Authorization Form....................................................................................... 109 Appendix 28 – Expense Reports ............................................................................................................... 110 Appendix 29 – Student-Athlete Host Agreement ..................................................................................... 112 Appendix 30 – Liability Release Waiver-Prospects ................................................................................... 113 Appendix 31 – Unofficial Visit Form.......................................................................................................... 114 Appendix 32 – Tryout Request Form ........................................................................................................ 115 Appendix 33 – Occasional Meal Form ...................................................................................................... 116 Appendix 34 – Institutional Camp/Clinic Form ......................................................................................... 117 Appendix 35 – Liability Release Waiver ALL Minors ................................................................................. 119 Appendix 36 – Outside Camp/Clinic Approval Form ................................................................................ 120 Appendix 37 – Student-Athlete Employment Form.................................................................................. 121 Appendix 38 – Federal Work Study Certification & Application Form ..................................................... 122
v
Appendix 39 – Declaration of Playing Season Form – Team Sports ......................................................... 123 Appendix 40 – Declaration of Playing Season Form – Individual Sports .................................................. 124 Appendix 41 – Countable Athletic Related Activities (CARA) Form .......................................................... 125 Appendix 42 – Competition Record .......................................................................................................... 126 Appendix 43 – Outside Competition Form ............................................................................................... 127
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Booster Education for Ursuline College Alumnae/Alumni and Friends Ursuline College is responsible for the actions of coaches, student-athletes and staff, as well as alumnae/alumni, boosters and fans. The following information is intended to help athletic boosters and organizations so they can best support college athletes without putting the institution at risk. BOOSTERS What is a booster? You are a Booster, or Representative of Athletics Interest, if you: Have participated in or ever have been a member of a booster organization that supports Ursuline athletics; Have made any financial contribution to the athletics department or any athletic organization; Have been involved in the recruitment of a prospect or have been asked to assist in the recruitment of a prospective student-athlete; Have provided or are providing benefits to an enrolled student-athlete or his or her relatives or friends; Have otherwise been involved in promoting Ursuline College athletic program in any way; Have helped arrange employment for student-athletes; Are a parent or guardian of an enrolled student-athlete; NOTE: Once someone has been identified as a Booster/representative of Ursuline athletics, they will retain that identity forever. RECRUITING What is a prospective student-athlete? A prospective student-athlete is any person who has begun classes in the ninth grade. In addition, a student who has not started classes for the ninth grade becomes a prospective student-athlete, if the institution provides a benefit or assistance not provided to prospective students in general. A prospective student-athlete remains so even after signing a National Letter of Intent or accepting financial aid and until they report for the first day of classes. What are Boosters prohibited from doing? Contacting a prospect in person on or off campus; Writing or telephoning a prospect or member of the prospect’s family; Making arrangements for the prospect or the prospect’s relatives or friends to receive money or financial aid; Providing transportation for a prospect or the prospect’s family or friends to visit the campus; Providing free tickets or reduced priced tickets to attend an athletic event to the prospect or the prospect’s family or friends; Entertaining coaches of prospects.
What are boosters permitted to do? Notify coaches about prospects in your area; Attend athletic contests where prospects compete, but may not contact the prospect or prospect’s relatives; Continue existing friendships with families of prospects, but not attempt to recruit.
ENROLLED STUDENT-ATHLETES What contact can Boosters have with currently enrolled student-athletes? A booster may not provide a student-athlete any benefit or special arrangement that would not be offered to the rest of the general student population. This would include: May not entertain student-athletes or their friends or family; May not purchase a meal or beverage for a student athlete; May not use the name or picture of an enrolled student-athlete to advertise, recommend, or promote any product or service; May not provide awards or gifts to student-athletes; May not allow a student-athlete to use a telephone to make free calls, or allow use of a free or discounted automobile; NOTE: An enrolled student-athlete may be invited to a booster’s home for an occasional home cooked meal, but may not be taken to a restaurant. NCAA regulations do not permit sponsor families or adopt-a-player arrangements. EMPLOYMENT A student-athlete may be employed so long as compensation is only for work actually performed, at a rate commensurate with the going rate in that locality for similar work, and the student-athlete was not hired based on athletics ability. Contact the Athletic Director before employing prospects or student-athletes. NOTE: Employment may be arranged for a prospect provided the employment does not begin before the completion of the prospects senior year. INSTITUTIONAL CONTROL Ursuline College is responsible for the actions of boosters and booster support groups. Boosters are regulated by the same NCAA rules and regulations placed upon all institutional athletics staff members. Ask before you act. Contact the Athletic Director Cindy McKnight or Compliance Coordinator Micki Stewart if you have questions.
74
URSULINE COLLEGE DRUG TESTING AUTHORIZATION AND RELEASE OF INFORMATION
I acknowledge receipt of a copy of Ursuline College’s Intercollegiate Athletics’ Drug Policy. I also acknowledge that I have read, understand and agree to comply with this policy. It is understood that signing and returning this consent form is a prerequisite to participating in athletics at Ursuline College. It is further understood that I will forgo an opportunity to play intercollegiate athletics at Ursuline College if I refuse to sign this consent form. I further authorize the Head Athletic Trainer at Ursuline College to make confidential releases to the Head Coach of any intercollegiate sport, in which I am a team member, the Athletic Director, the Compliance Coordinator, the team physician, and my parents/guardians (if I am a minor), of all information, including test results and records, pertaining to me, as a student-athlete, and obtained under the College’s drug screening/testing policy.
Date: __/__/__ Student-Athlete (Print)
Student-Athlete (Signature)
Intercollegiate Sport (s)
Date: __/__/__ Parent (print) – if minor
Parent (signature) – if minor
75
REQUEST FOR REASONABLE SUSPICION TEST Please fill out the following information for personally observed and not otherwise reasonably explained changes in the appearance or behavior of the athlete.
Name of Athlete:
Sport(s): ____________________________
Your Name: (If Coach – Sport you Coach): Please detail below your personally observed and/or unexplained changes in the athletes appearance, behavior, and/or performance that would lead you to suspect the athlete is using/abusing prohibited substances. Reasonable suspicion may be based on, but is not limited to: 1. Observed possession or use of substances appearing to be prohibited drugs 2. Previous positive drug test, refusal to take a drug test, or failure to appear for a drug test 3. Observed abnormal appearance, conduct or behavior that may cause someone to suspect the use or abuse of a banned substance. Examples of abnormal appearance, conduct or behavior may include, but are not limited to significant decline in academic or athletic performance, missing classes, significant weight gain or loss, increased injury rate or illness, lethargy, agitation, nervousness, short temper, or acts of violence Please make sure your descriptions are detailed and include dates and times if possible. Attach additional sheets if necessary. Please return this form to the Head Athletic Trainer in a sealed envelope.
Signature:
Date: __/__/__ 76
Volunteer / Independent Contractor Athletic personnel Agreement Ursuline College (“the College”) is a member institution of the National Collegiate Athletic Association (“NCAA”) and is subject to NCAA bylaws, rules, and regulations. In order to serve as a volunteer or independently contracted coach or other athletic personnel for Ursuline College, you must agree to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA. SERVICES TO BE RENDERED & FOR WHICH SPORT(S): DURATION OF SERVICES: CHECK ONLY ONE BOX:
Volunteer
Independent Contractor
BELOW SECTION TO BE COMPLETED BY VOLUNTEER OR INDEPENDENT CONTRACTOR FULL NAME: HOME ADDRESS (VOLUNTEERS): BUSINESS ADDRESS (CONTRACTORS): PHONE NUMBER & EMAIL ADDRESS: LIST ALL EMPLOYMENT & OTHERS CONTRACTING YOUR SERVICES: HAVE YOU EVER WORKED AS/FOR A SPORTS AGENT, FINANCIAL ADVISOR, ATHLETIC SCOUTING OR RECRUITING SERVICE, OR REPRESENTATIVE OF AN AGENT, ADVISOR, OR SCOUT/ RECRUITER (E.G., “RUNNER”)?
YES
NO
If Yes, please explain:
My signature below indicates the following:
I understand and agree that the head coach, athletic director, and/or appropriate administrator of the College shall determine my duties and responsibilities to the College as a volunteer or independently contracted coach.
I understand and acknowledge that I am not an employee of Ursuline College and this Agreement is not a contract of employment, nor is it intended to create an employment relationship of any kind.
While performing services under this Agreement, I agree to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA.
I acknowledge that I have received copies of the relevant bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA, and agree to carefully review these documents prior 77
to performing any services for the College under this Agreement. I further acknowledge and understand that the NCAA may consider me to be an “institutional staff member” for purposes of its bylaws, rules, and regulations.
I understand that my failure to abide by all applicable bylaws, rules and regulations of the College, the Great Midwest Athletic Conference, and the NCAA, while performing services under this Agreement, may lead to disciplinary or corrective action, including but not limited to: suspension of services (without pay for contractors) or permanent termination of services without any further obligation on behalf of the College (and without pay for contractors). I understand and agree that this provision shall govern over any other conflicting provision contained herein or in any other agreement I may be a party to with the College.
I agree to report to the appropriate College officials any knowledge I may have of violations of NCAA bylaws, rules, and regulations involving Ursuline College or its representatives. I also understand that I may be required to certify in writing, on an annual basis, that I have in fact reported any such knowledge I may have of violations to the appropriate College officials. I further agree to fully cooperate with any investigation conducted by the College and/or the NCAA into possible rule violations.
I understand that under NCAA Bylaws, I am prohibited from: o Contacting and evaluating prospective student-athletes off-campus (unless certified & authorized by the College). o Scouting recruits or opponents off-campus (unless certified & authorized by the College). o Promoting Ursuline athletics or sport programs (unless certified & authorized by the College). o Providing private sport lessons (unless younger than 9th grade) & working any sport camps/clinics that are not open to all.
For Volunteers Only: I understand and agree that I am prohibited from receiving any compensation from the College for services rendered under this Agreement, and the opportunity afforded to me by the College to work with and to share my knowledge with Ursuline student-athletes is sufficient consideration in exchange for the obligations incurred herein.
For Independent Contractors Only: I understand that the College requires me to maintain adequate insurance throughout the duration of this Agreement in amounts previously specified by the College and I agree to furnish the College with proof of such insurance coverage.
I understand that this Agreement shall expire upon the conclusion of the Duration of Services indicated above.
AGREED UPON BY THE FOLLOWING: __________________________________________ Volunteer or Independent Contractor (Signature)
Date ____/____/____
__________________________________________ Head Coach (Signature) if only one sport
Date ____/____/____
APPROVAL: __________________________________________ Athletic Director (Signature)
Date ____/____/____
__________________________________________ Compliance Coordinator (Signature)
Date ____/____/____
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Coaches who wish to do any private lessons, or coach local sports clubs (or any other athletic team outside of Ursuline College) must receive approval from the Compliance Coordinator prior to performing any coaching activities/duties. To receive approval, submit this completed form to the Compliance Coordinator along with any additional documentation required below. Once approved, the coach will receive a copy of the signed/approved form to confirm approval and begin coaching activities.
13.11.2.4 Local Sports Clubs In sports other than basketball, an institution's coach may be involved as a participant or in instructional or coaching activities in the same sport for a local sports club or organization located in the institution's home community, provided all prospective student-athletes participating are legal residents of the area (within a 100-mile radius of Ursuline). Further, in clubs or leagues involving multiple teams, the 100-mile radius is applicable only to the team with which the institution's coach is involved; however, it is not permissible for the coach to assign a prospect who lives outside the 100-mile area to another coach. A coach may be involved with club located in the institution's home community that includes prospects participating in a sport other than the coach's sport, regardless of where they reside. A coach also may be involved in activities with individuals who are not of prospective student-athlete age (before the 9th grade), regardless of where they reside.
13.11.3.8 Private Lessons An institution’s equestrian, golf or tennis coach may teach private equestrian, golf or tennis lessons to a prospective student-athlete provided the following are met: 1) The coach makes lessons available to the general public; 2) Fees charged are at a rate commensurate with fees charged to all individuals; 3) Prior written approval is received annually from the institution’s president; 4) Fees are not paid by individuals or entities other than the prospect’s relatives or legal guardians; 5) The institution keeps on file documentation of fees charged for the private lessons and the name of any individual receiving any portion of the fee.
(Check which applies in this instance): Local Sports Club High School or Summer League Team Private Lessons (Only permitted for prospect-aged individuals if in Golf/Tennis by Golf/Tennis coaches-attach sheet stating fees & individuals) Other – Please Specify: _________________________________ (Check any that apply in this instance): All members of the team are not of prospect age (under 9th grade). The team is in a sport other than what is coached at Ursuline College. The club or team is located in the home community of Ursuline College. All prospects on this team are legal residents of the area-within 100 miles of Ursuline College (Attach list of team members & permanent addresses). (Initials) (Initials)
No prospects have been reassigned to another team due to my participation. The club or team is not sponsored by Ursuline’s Athletic Department or any booster of Ursuline College.
Coach Name
Start Date
End Date
Club or League Name
Sport
Team Name
Club/League Address
Director’s Name
Director’s Phone #
By submitting and signing this form, I confirm the information contained is accurate and truthful. I also understand that all outside income from my outside coaching must be reported annually on the Athletically-Related Outside Income Form collected in August of each year.
Approved Denied Coach Signature
Date
Compliance Initials
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This form is to be used by all staff members as means of reporting athletic-related income and benefits received from sources outside the institution. A coach must receive annual written approval from the Athletic Director to: 1) RECEIVE any athletically-related income and benefits from sources outside the College. 2) USE directly or by implication the institution’s name or logo in the endorsement of commercial products or services. 3) SIGN any contractual agreements outside of Ursuline College. STAFF NAME
SPORT/OFFICE
ACADEMIC YEAR
DATE
Check here if no outside income was earned for the year. SOURCE
OVERALL # OF EVENTS
DESCRIPTION
SPEAKING ENGAGEMENTS ENDORSEMENTS TV OR RADIO COMMERCIALS/APPEARANCES CHARITABLE WORK SPORTS CAMPS & CLINICS LOCAL SPORTS CLUBS OTHER (PLEASE SPECIFY)
Staff Signature
Date
Athletic Director Signature
Date
Compliance Coordinator Signature
Date
80
Micki Stewart
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NAME: ______________________________________
SPORT: ______________________________________
Have you discussed your desire to transfer with the head coach?
____ Yes (Date:________) ____ No
(UC policy requires student-athletes to notify head coaches before permission/release will be given. It’s recommended for studentathletes to meet with head coach & both parties complete & sign this form - then turn it in to the Compliance Office IMMEDIATELY.)
Reason(s) for leaving: ________________________________________________________________________________ Institution(s) to which you would like Permission to Contact letter sent: _______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
NCAA Bylaw 13.1.1.2 Four-Year College Prospective Student-Athletes An athletics staff member or other representative of the institution’s athletics interests shall not make contact with the studentathlete of another NCAA four-year collegiate institution, directly or indirectly, without first obtaining the written permission of the first institution’s athletics director (or an athletics administrator designated by the athletics director) to do so, regardless of who makes the initial contact. If the institution decides to deny a student-athlete’s request to permit any other institution to contact the student-athlete about transferring, the athletics director (or his or her designee) shall inform the student-athlete in writing, within 14 consecutive calendar days from receipt of a student-athlete’s written request, that he or she, on request, shall be provided a hearing conducted by an institutional entity or committee outside of the athletics department.
____________________________________________ Student-Athlete Signature Date
_________________________________________ Head Coach Signature
_________________
________________
Date
Any objection to permission to contact? ____ Yes ____ No Any objection to full release? ____ Yes ____ No NOTES: ____________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
Date completed form received by coach or athletic administration: ________________ FOR COMPLIANCE USE ONLY Approved: ______ Denied: ______
Date: _______________ Date SA Notified: _______________
Appeal/Hearing Notification Given: _____ Yes (Date:___________)
No: ______
82
Micki Stewart
83
Micki Stewart
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STUDENT NAME: SPORT:
NAME OF INSTITUTION
2YR/4YR
DATES ATTENDED
PT/FT
HOURS
GRAD Y/N
TOTAL NUMBER OF FT SEMESTERS:
TRANSFERRABLE GPA: TRANSFERRABLE HOURS: DECLARED MAJOR (IF APPLICABLE):
QUALIFIER PARTIAL QUALIFIER NON QUALIFIER 2-YEAR REQUIREMENTS:
4-YEAR REQUIREMENTS:
N/A 9 SEM HRS PREVIOUS TERM N/A 12 SEM HRS AVG PER F/T TERM N/A 6 SEM HRS TRANSFERRABLE ENGLISH N/A 3 SEM HRS TRANSFERRABLE MATH
TRANSFER RELEASE FORM RECEIVED 9 TRANSFERRABLE SEM HRS PREVIOUS TERM
EXCEPTION(S) USED:
ELIGIBLE
NOT ELIGIBLE
DATE EVALUATION COMPLETED: COMPLETED BY:
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Name:
Today’s Date:
Sport(s):
Date of Birth:
Cell Phone:
Email:
LOCAL ADDRESS: (if off-campus check who you live with): Teammate Friend Parents Alone Spouse Other #/Street or Dorm Name/Room #
City
PERMANENT ADDRESS:
State
Zip
___________________________________________________________________________________________________________ #/Street
City
EMERGENCY CONTACT:
State
Zip
Name: ___________________________________________________ Relationship: ______________________________________ ___________________________________________________________________________________________________________ (Put “same” if same as permanent above) #/Street
City
State
Zip
Cell: _____________________________________________ Home Phone: _____________________________________________
HIGH SCHOOL GRADUATED FROM: ___________________________________________________________________________________________________________ Name
City
State
Month/Year Graduated
PRIOR COLLEGIATE ENROLLMENT (excluding summer school): 1) _________________________________________________________________________________________________________ School
Month/Year 1st Attended
Month/Year Last Attended
Sports Played: _______________________________________________ # of Years: _______________ 2) _________________________________________________________________________________________________________ School
Month/Year 1st Attended
Month/Year Last Attended
Sports Played: _______________________________________________ # of Years: _______________
EMPLOYMENT (everyone signs below): I understand that if I obtain new off-campus employment at any time throughout the year I must fill out a Student-Athlete Employment Form (found online). I also understand that any money paid for any employment must be for work actually performed. ___________________________________________________________________________________________________________ Student-Athlete (print)
Student-Athlete (signature)
Date
Do you currently have a job? Yes No Employer Name: __________________________________________________ Job Title, Duties & Pay: ________________________________________________________________________________________ 86
FINANCIAL AID: Do you have any outside scholarships that were not awarded by the government or Ursuline College?
Yes No
If Yes, please answer the following: Name(s): ___________________________________________________________________________________________________ Amount(s):__________________________________________________________________________________________________ Granting Organization(s): ______________________________________________________________________________________ Did any of these awards restrict where you could go to school?
Yes No
If Yes how?__________________________________________________________________________________________________
AMATEURISM & ELIGIBILITY: All Student-Athletes Have you ever accepted a loan, payment of expenses (travel, lodging, meals) or agreed orally or in writing to be represented by an agent or professional sports organization? Yes No Returning Student-Athletes Have you ever wagered a bet on a college or professional athletic contest since becoming a student-athlete? Have you competed in any organized competition, other than for Ursuline, since this time last year? If “Yes”, please give details :
Yes No
Yes No
__________________________________________________________________________________ __________________________________________________________________________________ Freshmen Student-Athletes Have you competed in any organized competition since requesting your NCAA amateurism certification? If “Yes”, please give details:
Yes No
__________________________________________________________________________________ NEW TRANSFERS OR NEW UPPERCLASSMAN ATHLETES – ONLY! Since graduating from high school, have you ever competed in organized athletics competition, either as an individual or as a member of a team that was not one of the college or university teams listed previously? Yes No If Yes, please explain:
*ALL STUDENT-ATHLETES*
If you have not continuously attended college as a full-time student each semester or quarter since graduating from high school, please describe your activities during that period you were not in school (i.e. work, military, church mission) and the dates of that time. Dates:
Reason:
Dates:
Reason:
RECRUITMENT STATUS: Did any coaches from Ursuline College Athletics initiate telephone calls or visit you, or a member of your family, off of Ursuline’s campus for the purpose of encouraging you to attend Ursuline College and participate in athletics? Yes No
I certify, upon penalty of ineligibility for intercollegiate athletics, that all statements contained within this document are complete and accurate, to the best of my knowledge. I also understand my responsibility to comply with all NCAA and Ursuline College requirements. If any of the information I have supplied in this report changes during the year, I will notify the Compliance Coordinator as soon as possible. Student-Athlete (Signature)
Date
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SSN/Student ID:________________________________________ Last Name:
Registration Form Fall 2017
First Name:
Middle Name
Address: City:
State:
Zip code
Phone:
Sex M F
Birth date
Ethnicity:
Marital Status:
Hispanic/Latino Y or N
Religious Preference:
Citizenship:
Check one or more
1-White 2-Black 4-Alaskan/American Indian 5-Asian 7- Native Hawaiian
1-Single 2-Married 3-Widowed 4-Divorced 5-Separated 6-Religious
Pending Date of Program Completion Educational Goal
Education Father: Education Mother
County
Catholic Jewish Protestant Other Not Declared
4-Permanent Resident List Country
May December BA Bachelor of Arts MA Master of Arts CC – Certificate of Completion
G-Middle School /Jr High H-High School G-Middle School /Jr High H-High School
Year ___________________ BSN Bachelor of Science in Nursing MSN Master of Science in Nursing No Specific Program
C-College or beyond O-Other/Unknown C-College or beyond O-Other/Unknown
Full Time
Employment Status Business Name Emergency Contact Name
U United States Citizen 1- F1 Visa- List Country
Not Employed Part Time Business Phone ( ) Emergency Contact Phone ( )
COMPLETE ALL OF THE ABOVE INFORMATION Students who have not attended for the past 24 months or more must be apply for readmission. Dept
No.
Sect
*Grade Option
Credit Hours
M
T
W
R
F
S
Instructor
Total Credit Hours
*Grade Option: P = Pass/No Credit
AD=Audit Grade Option Refer to the current Ursuline College Catalog for restrictions.
Alternate – please indicate an alternate course(s) in the event one of more courses are closed
Student E-Mail Address: Student Signature: Advisor Signature:
Date: Date:
Please note: Schedules WILL NOT be processed if the student has an outstanding financial obligation. Schedules WILL NOT be processed without an advisor signature.
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COURSE CHANGES SSN or ID#: ___________________________________________ DATE: ________________________________
NAME: _________________________________________________ ARE YOU A STUDENT ATHLETE?
YES___
SEMESTER: _________ YEAR: _________
NO___
Faculty Athletics Representative (FAR) Signature:________________________
ADDS Dept. Code
Course No.
DROPS *AU=Audit
Sect
CR
PN=Pass/ No Credit
Instructor
Dept. Code
Course No.
*AU=Audit Sect
CR
PN=Pass/ No Credit
Instructor
Drop all courses for the current term
*AU=Audit; PN= Pass No Credit grade options. Refer to current college catalog for grade option requirements. Reason: ___________________________________________________________________________________________ Advisor: __________________________________________________________
Date: _____________________
Student: __________________________________________________________
Date: _____________________
Distribution:
Student Service Center – Original
Financial Aid Office – Yellow
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CHANGE MAJOR/MINOR/CERTIFICATE/ADVISOR OR ADDITION OF SECOND MAJOR/MINOR/CERTIFICATE Effective for: ____________year
_____Fall
_____Spring
_____Summer
SSN/ID#________________________________________ Date: _____________________________ Name: ________________________________________________________________________________ Mailing Address: ___________________________________________________________________ Home Phone: ____________________________ Cell/Work Phone:______________________ I request a change of Advisor I request a change of { } Major
{ } Minor { } Certificate
From:_____________________________________________ To:________________________________________________ I request adding a { } Major { } Minor { } Certificate In:______________________________
Important: a change of major does not signify entry into the following programs: Nursing, education, social work, and long term care administration. Please follow the specific department of division procedures for formal admission into the program. I realize that this change might necessitate my taking additional courses and I am willing to do so in order to fulfill any requirements of my new academic major. ________________________________________________________________________________________________________________________ Student’s signature Date Approved By:_________________________________________________________________________________________________________ Current Advisor (please forward the student’s file to the new advisor) Your new advisor is:_________________________________________________________________________________________________ Office of ACADEMICaFFAIRS:_______________________________________________________________________________________ Date The office of Academic Affairs will return a copy of this form to you.
Original: Registrar Copy: Student Original Advisor New Advisor Revised 3/10
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TRANSIENT STUDENT FORM NAME:_____________________________SS#/ID#_________________________D ATE_______ MAILING ADDRESS___________________________________________________ STATUS: FRESHMAN___SOPHOMORE___JUNIOR___SENIOR___ Expected Graduation Date____ THIS STUDENT IS IN GOOD ACADEMIC STANDING (WITH G.P.A. 2.0 OR ABOVE) AT URSULINE COLLEGE.
PERMISSION TO REGISTER AT: COLLEGE OR UNIVERSITY_____________________________________________ FOR THE: SEMESTER(S) ____
FALL SEMESTER
QUARTER(S)
YEAR __________
____ FALL QUARTER
_____ SPRING SEMESTER
____ SPRING QUARTER
_____ SUMMER SEMESTER
____ SUMMER QUARTER
FOR THE FOLLOWING COURSE: COURSE NUMBER/TITLE ______________________________________CREDITS_________ WHICH WILL MEET THE URSULINE COLLEGE REQUIREMENT OF: _____________________________________________________________________________________ INDICATE COURSE NUMBER/TITLE IF A COURSE FOR MAJOR, OR INDICATE AS ELECTIVE CREDITS THIS STUDENT IS IN GOOD ACADEMIC STANDING (WITH G.P.A. 2.0 OR ABOVE) AT URSULINE COLLEGE.
APPROVED BY: ADVISOR___________________________________________ D ATE__________________ SCHOOL DEAN/OR OFFICE OF ACADEMIC AFFAIRS ___________________________________ (IF ATHLETE) FACULTY ATHLETICS REPRESENTATIVE (FAR) ___________________________________ UPON COMPLETION OF COURSE, THE STUDENT IS RESPONSIBLE FOR REQUESTING THAT A TRANSCRIPT BE SENT TO THE REGISTRAR’S OFFICE, URSULINE COLLEGE, 2550 LANDER RD., PEPPER PIKE, OH 44124. COURSES TAKEN AS A TR ANSIENT STUDENT WILL BE TRANSFERRED AS CREDIT HOURS EARNED O NLY: GRADES FROM TRANSFER CREDIT COURSES WILL NOT AFFECT THE STUDENT’S URSULINE COLLEGE GRADE POINT AVERAGE. THE OFFICE OF ACADEMIC AFFAIRS WILL DISTRIBUTE COPIES OF THIS FORM TO THE REGISTRAR, FINANCIAL AID OFFICE, ADVISOR, AND STUDENT.
*The Ursuline College Catalog states that in the semester before a student intends to graduate, she may not take courses away from Ursuline College. Approval to take a course off-campus does not constitute a waiver of this policy.
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TRANSIENT SUMMER EMAIL
November 9, 2015
RE: Taking a transient course during the summer 2015 term.
Dear Student Athlete, The Registrar’s Office has received your Transient Student Form for the summer 2015 term. It is your obligation to register for this course(s) at the college listed on the transient form. If you drop the course you should immediately notify the Registrar’s Office. Once you have completed the course, you need to have your official transcript mailed to Ursuline College. Have your official transcript mailed to: Ursuline College Admissions 2550 Lander Road Pepper Pike, Ohio 44124 If you have any questions, please do not hesitate to contact the Registrar’s Office.
Sincerely,
Leah Sullivan Registrar 440-646-8126
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Form 17-3e
Academic Year 2017-18
Drug-Testing Consent NCAA Division II For: Action: Due date: Required by: Purpose: Effective date:
Student-athletes. Sign and return to your director of athletics. At the time your intercollegiate squad first reports for practice or the first day of competition (whichever date occurs first). NCAA Constitution 3.3.4.10 and NCAA Bylaw 14.1.4.1 To assist in certifying eligibility. This consent form shall be in effect from the date this document is signed and shall remain in effect until a subsequent Drug Testing Consent Form is executed.
Requirement to Sign Drug-Testing Consent Form. Name of your institution: __________________________________________________________ Name of student-athlete: _____________________________________ Sport(s): ______________ You must sign this form to participate (i.e., practice or compete) in intercollegiate athletics per NCAA Constitution 3.3.4.10 and NCAA Bylaw 14.1.4.1. If you have any questions, you should discuss them with your director of athletics. Consent to Testing. You agree to allow the NCAA to test you on a year-round basis and in relation to any participation by you in any NCAA championship and in any postseason football game certified by the NCAA for the banned drugs listed in Bylaw 31.2.3 (attached). Examples of drugs under each class can be found at www.ncaa.org/drugtesting. Note: There is no complete list of banned substances. Check Drug Free Sport AXIS at 877-202-0769 or www.drugsfreesport.com/axis (Password: ncaa1, ncaa2, or ncaa3) for questions about supplements, medications and banned drugs.
Consequences for a Positive Drug Test. By signing this form, you affirm that you are aware of the NCAA drug-testing program, which provides:
1.
A student-athlete who tests positive for an NCAA banned drug must be immediately declared ineligible.
2.
A student-athlete who tests positive for a banned drug other than a “street drug” shall be withheld from competition in all sports for a minimum of 365 days from the drug-test collection date and shall lose a year of eligibility. A student-athlete who tests positive for a “street drug” shall be withheld from competition for 50 percent of a season in all sports (at least the first 50 percent of all contests or dates of competition in the season following the positive test);
3.
A student-athlete who tests positive has an opportunity to appeal the sanctions resulting from the positive drug test.
4.
A student-athlete who tests positive a second time for the use of any drug other than a “street drug” shall lose all remaining regular-season and postseason eligibility in all sports. A student93
Form 17-3e Page No. 2 _________ athlete who tests positive a second time for a street drug shall be withheld from competition for 365 days from the date of the test and shall lose an additional year of eligibility; 5.
The penalty for missing a scheduled drug test is the same as the penalty for testing positive for the use of a banned drug other than a street drug.
6.
A student-athlete found to have tampered with an NCAA drug-test sample shall be charged with the loss of a minimum of two seasons of competition in all sports and shall remain ineligible for all regular-season and postseason competition during the time period ending two calendar years (730 days) from the date of the test.
7.
If a student-athlete transfers to a non-NCAA institution while ineligible because of a positive NCAA drug test, and competes in collegiate competition within the prescribed penalty at a 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 the entirety of the prescribed penalty.
Signatures. By signing below, I consent: 1.
To be tested by the NCAA in accordance with NCAA drug-testing policy, which provides among other things that: a.
I will be notified of selection to be tested;
b.
I must appear for NCAA testing or be sanctioned for a positive drug test; and
c.
My urine sample collection will be observed by a person of my same gender;
2.
To accept the consequences of a positive drug test or a breach of drug testing protocol;
3.
To allow my drug-test sample to be used by the NCAA drug-testing laboratories for research purposes to improve drug-testing detection; and
4.
To allow disclosure of my drug-testing results only for purposes related to eligibility for participation in NCAA competition.
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Form 15-3e Page No. 3 _________
I understand that if I sign this statement falsely or erroneously, I violate NCAA legislation on ethical conduct, and will jeopardize my eligibility.
Date
Signature of student-athlete
Date
Signature of parent (if student-athlete is a minor)
Name (please print)
Date of birth
Age
Home address (street, city, state and zip code)
Sport(s)
What to do with this form: Sign and return it to your director of athletics at the time your intercollegiate squad first reports for practice or before the first date of competition (whichever date occurs first). This form is to be kept on file at the institution for six years.
95
Form 17-3b
Academic Year 2017-18
Student-Athlete Statement NCAA Division II For: Action: Due date: Required by: Purpose: Effective Date:
Student-athletes. Sign and return to your director of athletics. Before you first compete each year. NCAA Constitution 3.3.4.9 and NCAA Bylaw 14.1.3. To assist in certifying eligibility. This NCAA Division II Student-Athlete Statement/DrugTesting Consent form shall be in effect from the date this document is signed and shall remain in effect until a subsequent NCAA Division II Student-Athlete Statement/Drug-Testing Consent form is executed.
Student-Athlete: (Please print name) Name of your institution:
Sport: This form has five parts: a statement concerning eligibility, a Buckley Amendment consent, results of drug tests, an affirmation of a valid ACT or SAT score and a statement concerning the amateur status of the student-athlete subsequent to the request of final certification by the NCAA Eligibility Center. If you are an incoming freshman you must sign parts I through V of this form to participate in intercollegiate competition. If you are a transfer or continuing student-athlete, you must sign parts I through IV. By signing this form, you affirm you have received and will read the Summary of NCAA Regulations, or another outline or summary of NCAA legislation, provided by your director of athletics, or read the bylaws of the NCAA Division II Manual that deal with your eligibility. You are responsible for knowing and understanding the application of all NCAA Division II bylaws related to your eligibility. If you have any questions, you should discuss them with your director of athletics, or you may contact the NCAA at 317/917-6222 or consult the NCAA website at www.ncaa.org. 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 II Manual: •
NCAA Constitution 3.3.4.9 and NCAA Bylaws 14.1.3, 14.1.3.2 and 18.4.1.5.7.
96
Form 17-3b Page No. 2 _________
Part I: Statement Concerning Eligibility. You affirm that you have been provided and will read the Summary of NCAA Regulations, or another outline or summary of NCAA legislation, or the relevant sections of the Division II 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 have knowledge of and understand the application of NCAA Division II bylaws related to your eligibility. By signing this part of the form you affirm that, to the best of your knowledge, you have not violated any NCAA 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 2017-18 Drug-Testing Consent (Form No. 17-3e). You affirm that you will report 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 further will jeopardize your eligibility.
Name of student-athlete (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)
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Form 17-3b Page No. 3 _________
Part II: Buckley Amendment Consent. By signing this part of the form you certify that you agree to disclose your education records. You understand that this entire form and the results of any NCAA drug test you may take are part of your education 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: 1.
This form;
2.
Results of NCAA drug tests and related information and correspondence;
3.
Results of positive drug tests administered by a non-NCAA national or international sports governing body;
4.
Any transcript from your high school, this institution or any junior college or other fouryear institution you have attended;
5.
Precollege test scores, appropriately related information and correspondence (e.g., testing sites, dates and letters of test-score certification or appeal) and, where applicable, information relating to eligibility for or conduct of nonstandard testing;
6.
Graduation status;
7.
Race and gender identification;
8.
Diagnosis of any education-impacting disabilities;
9.
Accommodations provided or approved and other information related to any educationimpacting disabilities in all secondary and postsecondary schools;
10.
Records concerning your financial aid; and
11.
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 academic success, for awards and recognition programs highlighting student-athlete academic 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
98
Form 17-3b Page No. 4 _________ 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 studentathlete reinstatement case, infractions case or waiver request or to recognize your selection for an academic award (e.g., Elite 89). 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 of student-athlete (please print) Signature of student-athlete
Date
99
Form 17-3b Page No. 5 _________
Part III: Results of Drug Tests. 1. Future positive test – all student-athletes sign. Should I test positive for a substance banned by the NCAA and/or by a sports governing body that has adopted the World Anti-Doping Agency (WADA) code, or violate a drug-testing protocol or fail to show for a drug test at any time after I sign this statement, I acknowledge I must report the results to my director of athletics.
Name of student-athlete (please print)
Date
Signature of student-athlete 2. Positive test by NCAA or other sports governing body -- sign either A or B. A.
No positive drug test. I affirm that I have never tested positive for a substance banned by the NCAA and/or a sports governing body that has adopted the WADA code, nor violated a drug-testing protocol or failed to show for a drug test conducted by the NCAA or a sports governing body. ____________________________________________________ Name of student-athlete (please print) _________________________________ _______________ Signature of student-athlete Date
B.
Positive drug test. I have tested positive for a substance banned by the NCAA and/or by a sports governing body that has adopted the WADA code, or have violated a drug-testing protocol or failed to show for a drug test conducted by the NCAA or a sports governing body. If I transfer to another institution, I am also obligated to report this information to that institution. Name Signature Date of test
Organization conducting test
Substance
Are you currently under such a drug-testing suspension? Yes ____ No ____ 100
Form 17-3b Page No. 6 _________ Part IV: Affirmation of Status as an Amateur Athlete. You affirm that you have read and understand the NCAA amateurism rules. By signing this part of the form you affirm that, to the best of your knowledge, you have not violated any amateurism rules since you requested a final certification from the Eligibility Center or since the last time that you signed a Division II student-athlete statement, whichever occurred later. You affirm that since requesting a final certification from the Eligibility Center, you have not provided false or misleading information concerning your amateurism status to the NCAA, the Eligibility Center and the institution's athletics department, including administrative personnel and the coaching staff. Name of student-athlete (please print)
Date
Signature of student-athlete
Part VI: Incoming Freshmen – Affirmation of Valid ACT or SAT Score. You affirm that, to the best of your knowledge, you have received a validated ACT and/or SAT score. You agree that, in the event you are or have been notified by ACT or SAT of the possibility of an invalidated test score, you immediately will notify the director of athletics of your institution. Name of student-athlete (please print)
Date
Signature of student-athlete ______________________________________________________________________________ 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 director of athletics or you may contact the NCAA at 317/917-6222.
101
Student-Athlete Authorization/Consent for Disclosure of Protected Health Information for NCAA-Related Research Purposes
I, ____________________________ hereby authorize ___________________________________ Name of Student-Athlete Name of my Institution and its physicians, athletic trainers and health care personnel to disclose my protected health information including, without limitation, any information regarding any injury, illness, treatment or participation related to or affecting my training for and participation in intercollegiate athletics to the National Collegiate Athletic Association (NCAA), and its designated employees, agents and/or contractors. I further authorize the NCAA to disclose, and/or use, such information as provided herein. I understand that my participation and protected health information may be disclosed to, and/or used by, the NCAA, and authorized third parties to receive such information for the purpose of using injury, relevant illness and participation information collected from multiple student-athletes and institutions in a manner that does not identify myself or my school. The information is provided to NCAA committees, athletics conferences and individual schools, and NCAA-approved researchers to evaluate the effectiveness of health and safety rules and policy, and to study other sports medicine questions. Selected de-identified summary (aggregate) data also are made accessible to the general public as a service to further the general understanding of athletic injury patterns and help develop education on student-athlete health topics. I am making this authorization/consent voluntarily to release my health information otherwise protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment). The NCAA and institution are not requiring this authorization/consent to be signed. I understand that while HIPAA regulations may not apply to NCAA use or disclosure of my injury/illness information, the NCAA is committed to protecting my privacy. I understand that my data will be stored securely within industry standards. This authorization/consent for transfer of protected health information expires 545 days from the date of my signature below, but I have the right to revoke it in writing at any time by sending written notification to the director of athletics at my institution. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date.
Printed Name of Student-Athlete
Signature of parent or legal guardian (if Student-athlete is a minor)
___________________________________ Signature Date _______________ Date
102
G-MAC Sportsmanship Statement The Presidents, Faculty Athletic Representatives, Athletics Directors, Senior Woman Administrators and coaches in the conference are committed to maintaining sportsmanship and healthy competitive environments. The G-MAC will strive to promote environments that are hospitable; the conference does not believe that it is desirable to create a hostile environment for intercollegiate athletic contests. The members believe that part of the mission of intercollegiate athletic programs, within an educational context, should be to set an example for students and communities of how to act with sportsmanship and respect for opponents. Therefore, the G-MAC expects all participants to treat opponents and officials with respect. Failure to do so may lead to penalties. Trash talking, taunting, baiting, celebrations that demean opponents, vulgar or profane language, intimidating actions, fighting, attempts to injure, and any other malicious or violent conduct may be penalized by contest officials and /or the conference. G-MAC Student-Athlete Pledge of Sportsmanship As a Great Midwest Athletic Conference student-athlete, I understand that the use of inappropriate language, taunting, baiting or the use of unwarranted physical contact, directed at opposing players, coaches, or fans are contrary to the spirit of fair play and the sportsmanship the conference expects of its members. I understand that any unsportsmanlike action during the course of the contest may result in an immediate penalty assessed to me or my team. Furthermore, I understand that game officials have been instructed that they may assess such penalties without prior warning. In signing this form, I pledge my efforts to promote G-MAC sportsmanship policies. _________________________________________________________________ Print Name _________________________________________________________________ Signature _________________________________________________________________ Date
103
URSULINE COLLEGE PROMOTIONAL AUTHORIZATION In accordance with NCAA Bylaw 12.5.1.1, I give my permission to authorized representatives of Ursuline College to use my name, picture, identity, appearance and personal academic (e.g., cumulative GPA, academic major) and athletic (e.g., batting average, points, yards) statistics for institutional and community promotional activities. Promotional activities include but are not limited to game promotional activities, ticket sales, press releases, information provided for articles and stories by outside media entities, fundraisers, posters, schedule cards, calendars, institutional charitable or community activities, booster functions, and institutional marketing (e.g., admissions). All monies derived from such promotions are required to be provided directly to Ursuline College.
Academic Year: Student Name (Print First & Last):
Student Signature:
Date:
*Note: If a student is under the age of 18, please ensure the signature of the parent/guardian is on file.
104
Great Midwest Athletic Conference Request for Medical Hardship Waiver Submitting Institution: _________________________________
Sport: ___________________________________________
Name of Student-Athlete: _______________________________
Academic Year of Waiver Request: ___________________ (Year the injury/illness occurred)
All hardship waiver requests must comply with NCAA Bylaw 14.2.5 and G-MAC policies
Participation Information 1. Did the Student-Athlete’s injury or illness occur in one of the four seasons of intercollegiate athletic competition? Yes No Institution where injury or illness occurred: ___________________________________ 2. Date of injury or illness: ____________________________ 3. Did the injury or illness occur prior to the Student-Athlete’s participation in (1) more than two contests or dates of competition; (2) 20% of the institution’s completed contests or dates of competition; or (3) 20% of the maximum permissible number of contest of dates of competition as set forth in Bylaw 17 in his/her sport?
Yes No *Note: Only competition against outside participants during traditional playing season shall be counted. Scrimmages and exhibition against outside competition shall NOT be counted. 4. The Student-Athlete participated in _______ contests/dates of competition during the championship segment. 5. Description of injury/illness: _____________________________________________________________________
The following items MUST be attached to this form at the time of submission: 1. 2. 2. 3. B.
A complete copy of the institution’s published schedule with clear identification of regular season contests. Individual performance statistics for the Student-Athlete requesting the hardship waiver. A signed Buckley Statement from the Student-Athlete requesting the hardship waiver. Contemporaneous medical documentation from a medical doctor that includes the following: Validation of the timing of the injury or illness – required; C. 1. Contemporaneous letter or diagnosis from treating physician identifying injury/illness as “incapacitating” OR Noncontemporaneous letter or diagnosis from treating physician identifying injury/illness as “incapacitating” AND 2. Treatment logs or athletic trainer’s room notes (indicating continuing rehabilitating efforts); (C) 1. Estimated length of incapacitation or recovery time range contained within original contemporaneous medical documentation AND 2. Contemporaneous documentation of follow-up doctor’s visits (within the estimated time range) in which the student-athlete cleared to resume playing OR Treatment logs or athletic trainer’s room notes (indicating continuing rehabilitation efforts). I hereby certify that to the best of my knowledge, the above & attached information is accurate & complete.
Director or Athletics Signature: ______________________________________ Date: ___________________ Student-Athlete Signature: __________________________________________ Date: ___________________ Compliance Coordinator Signature: ___________________________________ Date: ___________________ CONFERENCE USE ONLY – To be completed by Commissioner or Designee Request Approved
Request Denied
Signature: _____________________________ Date: ____________
105
Grant-In-Aid Request Form (GIAR)
(Please PRINT clearly)
This form is required to be completed for all initial athletic awards and also any increases, reductions or cancellations to athletic scholarships. Renewals will be submitted via summary lists each Spring. Instructions: Head Coaches should submit this form to the Athletic Director for approval. If approved, the form should be given to the Compliance Coordinator to review, create and send the official Athletic Scholarship Letter/NLI. Once the scholarship letter is prepared, the department secretary should forward copies of this form and the official offer letter to the Compliance Coordinator and Director of Financial Aid. Academic Year: ____________________________ Date: __________________
Letter(s):
Sport: _______________________________________
UC Scholarship only NLI & UC Scholarship
NCAA Eligibility Center ID #: _______________________
Ursuline Acceptance Date: _______________________
Student Name:
Email: ______________________________________
__________________________________
Compliance email the letter & info Address:
Fwd to coach for coach to email the letter & info
______________________________________________________________________________ ______________________________________________________________________________
Period of Award:
Academic Year
Spring Semester Only
Type of Award:
Initial Award
Increase
Athletic Award Amount:
Fall Semester Only
Reduction
Cancellation
Flat Athletic Dollar Amount $____________________ Full Tuition – Up to ___________ credit hours per year Full Grant-In-Aid (including Room & Board) – Up to ___________ credit hours per year
For either full award:
Do not include any fees Include course fees Include tech fees Include parking fees
List any other UC awards, in addition to the above athletic scholarship, you believe to be included in the aid package: ____________________________________________________________________________________ Award amounts are distributed equally (dependent on credit hours taken) between Fall and Spring Semesters. Room & Board dollars can only be applied to Ursuline College residence hall fees. Books are currently not included in athletic scholarships.
NOTES : ____________________________________________________________________________________
______________________________________ Head Coach Signature
______________________________________ Athletic Director Signature
_________________ Date
_________________ Date
Date copies forwarded to the Compliance Coordinator and Financial Aid Director: ______________
106
107
May 9th, 2015
108
109
110
111
112
113
PROSPECT NAME:
SPORT:
ACCOMPANIED BY:
ARRIVAL DATE:
[NAME(S)] RELATIONSHIP:
DEPARTURE DATE:
[ EX: FATHER ]
NAM SCHOOL:
GRADUATION YEAR:
CURRENT STATUS:
HS SR HS JR HS SOPH HS FR 2-YEAR 4-YEAR
ENTERTAINMENT During an unofficial visit, the College may not pay any expenses or provide any entertainment except complimentary admissions (maximum of 3) to a campus athletics event in which the institution’s intercollegiate team practices or competes. Were complimentary admissions given to this prospect? Yes (Contest:_____________________) No MEALS All DII institutions may provide a prospect and the prospect’s parents or legal guardians with one (1) meal during an unofficial visit to campus. New legislation permits this meal to be on or off-campus, granted it is in the locale of the College (no more than 30 miles).
Yes
Were prospect and/or parents provided a meal? If Yes, please select :
No
Breakfast Lunch Dinner
Where was the meal located? How was the meal paid for? TRANSPORTATION During an unofficial visit, the College may provide the prospect with transportation only to view off-campus practice and competition sites in the prospect’s sport and other institutional facilities (located within a 30-mile radius of campus). An institutional staff member must accompany the prospect during such a trip. Payment of other transportation expenses shall cause the trip to become an official paid visit. Was prospect provided transportation during the unofficial visit? If yes, please describe the transportation
Yes No
and list driver
.
LODGING At this time Ursuline College does not charge students to have guests stay overnight in their dorm rooms. Payment of any other lodging expenses shall cause the trip to become an official paid visit. Did prospect stay in a residence hall with a current student-athlete? If No, did the prospect or her parent/guardian pay for their lodging? Coach Signature
Yes No N/A Yes No Date
114
SPORT:
TRYOUT DATE:
PROSPECT/STUDENT NAME:
DATE OF BIRTH:
EMAIL:
PHONE:
ADDRESS: Does this student currently attend Ursuline College? No Yes Was this individual ever recruited by Ursuline College? No Yes
(If yes and a current Ursuline student, a tryout is NOT permitted.)
TRYOUT REGULATIONS:
All tryouts must occur at Ursuline College’s regular practice or competition facilities. No more than one (1) tryout per student (prospective or currently enrolled) per sport is permitted. All high school prospects must have either exhausted eligibility in the sport or be outside of their sport season (not in the time from the first practice through the final contest). Transfer prospects must have concluded their sport season or can be conducted anytime if they have exhausted their eligibility (2-year prospects). Equipment and clothing may be provided for tryout activities, but only on an issuance-and-retrieval basis. No tryout can last longer than two (2) hours. Prior to participation in any activities, documentation must be provided showing a medical exam has been given within six (6) months prior to the tryout. The examination or evaluation shall include a sickle cell solubility test (SST), unless documented results of a prior test are provided to Ursuline or the prospective student-athlete declines the test and signs a written release. See instructions below for further details.
HIGH SCHOOL ATTENDANCE Name of School:
Graduation Date:
Sports Played: ________________________________________ Has the individual exhausted eligibility in this sport? If no, practice start date: ____________________
No Yes
Date of last competition: ____________________
COLLEGE ATTENDANCE Name of Institution
2yr / 4yr
Dates Attended
FT/PT
Sports Played: ________________________________________ Has the individual exhausted eligibility in this sport? If no, practice start date: ____________________
Graduated ?
No Yes
Date of last competition: ____________________
INSTRUCTIONS All individuals (and parent/guardian if a minor) need to complete and sign a Prospective Student-Athlete Liability Release Waiver prior to participation in any Tryout activities. All documentation must be given to the Compliance Coordinator for approval before any tryout activities may occur. For prospective studentathletes this must be done no later than 1 business day before the proposed tryout. For current Ursuline students this must be done no later than 1 week prior to the proposed tryout.
APPROVAL Compliance Coordinator (or AD in absence) Signature:
Date: 115
116
INSTITUTIONAL CAMP/CLINIC FORM COACH:
SPORT:
CAMP NAME:
CAMP ADMINISTRATOR: (IF OTHER THAN COACH):
PLEASE COMPLETE ALL OF THE FOLLOWING ABOUT THIS CAMP/CLINIC: Proposed Dates of Camp/Clinic: Location of Camp/Clinic: Facilities Utilized for Camp/Clinic: Purpose of Camp/Clinic: Housing for Campers: Housing for Employees: Camp Fee: Is this camp/clinic restricted or limited in any manner regarding campers (i.e. age, class, # campers)? If yes, please list how:
Yes No
Will the campers receive any items or awards as part of their camp payment (i.e. t-shirt, bag, trophy)? If yes, please list items/possible awards:
Yes No
List all methods of advertisement or solicitation for this camp/clinic (i.e. brochure, email, ads). Attach copies of each. All brochures or advertisements must be approved by Compliance Coordinator prior to printing and disbursement.
Do you have any partnerships or agreements with any individuals, organizations or companies outside of Ursuline College? If yes, please list name and relationship/camp function below: Yes No
Will any free/reduced admissions be available to campers? (If yes, check type below & attach list of all recipients for each) Yes No (All discounts must be published & provided to all individuals in given category, otherwise they are not permissible)
Child of coach/administrator working the camp/clinic Child of Ursuline College faculty/staff Group rate Early or online registration Other (specify, approval required prior to use) 117
EMPLOYMENT: COACHES/ADMINISTRATORS NCAA member schools are permitted to employ high school, prep school or two-year college coaches provided:
Compensation is at the going rate for similar ability or experience Compensation is not on the basis of the coach’s reputation or contact with prospects Compensation is not based on the number of campers a coach sends to the camp/clinic
STUDENT-ATHLETES NCAA member schools are permitted to employ college student-athletes (including our own) provided:
Duties are of a general supervisory nature in addition to coaching or officiating Compensation is at the going rate for teaching ability or camp experience, and not based on athletics reputation or athletics skill level No organized practice activities take place during or in conjunction with the camp/clinic
SUMMARY: As specified within this document, please attach the following with this form and submit to the Compliance Coordinator no later than one month prior to the camp/clinic:
Any brochures or advertisements for this camp/clinic (prior approval required prior to printing & distributing). List of any free or reduced admission offered, including all campers that fall within that category. List of all coaches and administrators employed by the camp/clinic (including name, school affiliation, position, compensation and
List of all student-athletes employed at this camp/clinic (including name, sport team, duties and compensation).
experience).
PRIOR to the start of any camp/clinic activities the coach must have on file a completed and signed Liability Release Waiver-ALL Minors for every camper. Waiver forms can be found under the Compliance folder on the Athletics “M” drive.
At the conclusion of the camp/clinic the coach is responsible for submitting the following to the Compliance Coordinator:
Either copies or originals of all waiver forms for campers. Records or ledgers of camp expenses and camper payments.
I am aware of all NCAA rules (NCAA Bylaw 13.12) regarding camps and clinics and confirm that the above information is true and accurate, and that all attendance and employment of this camp complies with the rules and regulations of the NCAA to the best of my knowledge. Subsequent to this date, I will notify the Compliance coordinator of any potential problems or violations that may arise regarding this camp/clinic.
Head Coach
Date
Compliance Coordinator or Athletic Director Signature
Date
118
119
OUTSIDE CAMP/CLINIC APPROVAL FORM COACH or STUDENT-ATHLETE: Please submit the following information to the Compliance Coordinator, or Athletic Director in his/her absence at least two weeks prior to working the camp/clinic. NAME:
SPORT:
NAME OF CAMP/CLINIC:
Private Institutional (if so, name of school): LOCATION: NAME OF CAMP/CLINIC DIRECTOR: DIRECTOR ‘S EMAIL: DIRECTOR
PHONE:
CAMP/CLINIC DATES: WORK TO BE PERFORMED: SALARY:
Yes No
Is this camp/clinic restricted or limited in any manner regarding campers (i.e. age, class, # campers)? If yes, please list how:
TRAVEL ARRANGEMENTS: Yes No Yes No
Camp/clinic is paying for travel to/from site If camp/clinic is paying for transportation; this is the policy for all camp employees
I understand the NCAA rules (Bylaw 13.12) regarding outside camps and clinics, including the following statements:
If a coach, I understand that athletics department personnel may serve in any capacity at a privately owned camp or clinic provided it’s operated in accordance with all NCAA rules: Open to general public (except for restrictions in age or number of participants), No free/reduce admission to prospects, Conducted primarily for educational purposes & fundamentals skills & does not include material benefits, Participants do not receive a recruiting presentation, All participants reside within 100 miles of the camp/clinic.
If a coach, I understand that I may not be employed (salaried or volunteer) in any capacity by a camp or clinic that provides recruiting or scouting services. If a student-athlete, I understand that I must perform duties that are of a general supervisory nature in addition to any coaching or officiating assignments. If a student-athlete, I understand that I must be paid the same as other employees with similar camp/clinic ability or experience, and if I only lecture or demonstrate I may not receive compensation.
Approved Denied
If denied, rationale:
Coach or Student-Athlete Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
120
STUDENT-ATHLETE EMPLOYMENT FORM Student-Athlete Name:
Date:
Sport(s): Local Address: Permanent Address: Employer Name: Employer Address: Contact/Supervisor:
Phone:
Position(s): Description of Duties:
Rate of Pay: $ Dates of Employment:
/Hour
$
/Week
$
From:
Did anyone connected with Ursuline Athletics help you get this job?
/Month
$
/Project
Full-time Part-time
To: Yes No
If Yes, who was it & how did they help?
Student-Athlete (Signature)
Date:
121
2017-2018 FEDERAL WORK STUDY CERTIFICATION AND APPLICATION The below student has qualified for employment under the Federal Work Study Program for the 2011/2012 school year. The awarded amount is the maximum amount the student may earn during the 2010/2011 school year.
NAME:
AWARD AMOUNT: $
Students who wish to work on campus or those who wish to work off campus for the America Reads Program must complete this form. If this is your first time being employed at Ursuline College; you must also submit the appropriate tax forms (I-9, W-4, and Ohio withholding form).
TO BE COMPLETED BY STUDENT: NAME ____________________________________________
STUDENT ID _____________________________
ADDRESS _________________________________________
CITY, STATE, ZIP ________________________
PHONE NUMBER ___________________ Please list your previous work experience, including company’s name, dates of employment, and basic responsibilities: 1) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 2) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 3) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Please list any additional qualifications and skills: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Days Available for work:
Monday______ Tuesday______ Wednesday______ Thursday______ Friday______
Saturday______ Sunday______
STUDENT SIGNATURE _______________________________________
To be completed by employer Student’s Job Title _____________________________________________ Department _____________________________________
Hourly Pay rate __________________
Date of Hire ______________________
Employer Name (printed) _______________________________________________ Employer Signature ___________________________________________________
122
SPORT:
ACADEMIC YEAR:
HEAD COACH:
DATE:
In accordance with NCAA Bylaw 17.1.3, I hereby declare my playing season as follows: Number of Contests (Max __, Min__): Number of Scrimmages (up to __): Number of Exemptions (Please specify below):
CHAMPIONSHIP SEGMENT First Permissible Practice Date: First Actual Practice Date: First Permissible Competition Date: First Actual Competition Date: Last Competition Date:
NON- CHAMPIONSHIP SEGMENT First Permissible Start Date: First Actual Practice Date: Last Permissible End Date: Actual End Date Date:
PLEASE ENCLOSE WITH THIS DOCUMENT: A schedule of all contests for the academic year A roster of all team members (as of this date) with freshman and new transfers indicated
Head Coach Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
123
SPORT:
ACADEMIC YEAR:
HEAD COACH:
DATE:
In accordance with NCAA Bylaw 17.1.3, I hereby declare my playing season as follows below: Dates of Competition ( ______ max): Number of Contests ( ______ min): Number of Scrimmages: Number of Exemptions (Please specify below):
Total Days Permitted in Playing Season ( _____ ):
CHAMPIONSHIP SEGMENT 1 Days Used in Segment 1: First Permissible Practice Date: First Actual Practice Date: First Permissible Competition Date: First Actual Competition Date: Last Competition Date:
CHAMPIONSHIP SEGMENT 2 Days used in Segment 2: First Permissible Start Date: First Actual Start Date: Last Permissible End Date: Actual End Date:
PLEASE ENCLOSE WITH THIS DOCUMENT: A schedule of all contests for the academic year A roster of all team members (as of this date) with freshman and new transfers indicated Head Coach Signature
Date
Compliance Coordinator or Athletic Director Signature
Date
124
2017-18 CARA FORM PLAYING & PRACTICE SEASONS – DAILY & WEEKLY HOUR LIMITATIONS Per NCAA regulations, each intercollegiate sport program must record on a daily basis any countable athletically related activity. All activities must count against the following NCAA limits: IN-SEASON = = four (4) hours/ day, twenty (20) hours/week with one (1) day off per week OUT-OF-SEASON = eight (8) hours/week [2 of the 8 hours can be individual skill instruction] with (2) days off per week
SPORT:
WEEK of SUNDAY
to SATURDAY
*REMINDER – Competition always counts as 3 hours regardless of how long it lasts*
Sunday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Monday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Tuesday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Wednesday
Thursday
Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Friday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
Saturday Competition Practice Skill Instruction Conditioning Weights Meeting Film OFF DAY’S TOTAL
WEEK’S TOTAL Sum of all day’s totals for the week below.
Any individual exceptions to above team activities can be recorded below…
STUDENT-ATHLETE NAME
DAY/DATE
ACTIVITY/HOURS
STUDENT-ATHLETE NAME
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
COACH’S SIGNATURE
DATE
SAAC MEMBER SIGNATURE
DATE
DAY/DATE
ACTIVITY/HOURS
COMPLIANCE COORDINATOR’S SIGNATURE
DATE
Forms to be submitted to the Compliance Coordinator on the Monday following the week above
125
2011-12 Competition Record
Instructions 1
Basketball
2
Date - First Contest (including scrimmages/exhibitions) :
3
Date - Last Regular Season Contest: Date - Final Post-Season Competition:
4
Head Coach:
5
Captain (s):
6 7 8 9 10
No Competition M=Medical C = Cut Q = Quit
On or After Comp Start Date
O = Other
Y=Yes
N=No
Class Year
◄Provide the information requested on the left side of the page. Student-Athlete List. This list is to include the names of all student-athletes who were on the squad on the date of the first practice of the academic year, as well as those of any student-athlete who joined the team after the first practice. Any missing names are to be typed in at the bottom of the list. Record Name of Opponent or Event and Date of Competition. List contests in chronological order with the name of the opponent or event above the date. Every contest in which a squad member represents Ursuline is to be listed (including scrimmages and exhibitions). Use one column for each day of competition. Record Student-Athlete's Participation in Competition. Place the number "1" in the corresponding contest column for all competitions in which a squad member has participated. Student-Athlete did not participate in any outside competition. Record reason for non-participation in the No Competition column [M=Medical, C=Cut/Dismissed, P= Practice Only, Q=Quit]. Indicate "Y" if reason for no competition occurred on or after date of first countable competition or "N" if reason occurred before date of first countable competition. Record Letter Winner indicator of "Y". In the Letter Winner column, indicate those squad members who satisfy the criteria for a varsity letter. Position column is to be completed by the following field sport programs ONLY - lacrosse, soccer and softball. Total Team Competitions column is for Compliance Office use only. Please do not record any data in this column. Submitter's Name and date of submission. The name of coach completing this report and the date of submission are to be typed into the spaces indicated Completed Competition Record is to be submitted electronically (email attachment) not later than 7 days following the last regular season date of competition. Submit to the Compliance Coordinator at [email protected] Retain a copy for your files.
Letter Student-Athlete
Winner
Position
Carlow
UM Dearborn
Roberts
Houghton
Lake Erie
LaRoche
Marietta
Notre Dame
Cedarv ille
Wooster
Oberlin
Total Team
6-Nov
10-Nov
12-Nov
13-Nov
15-Nov
20-Nov
23-Nov
30-Nov
4-Dec
8-Dec
10-Dec
Competitions
1 1
1 1
1
1 1
1 1
1 1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
11 8 10 11 3 7 11 11 9 11 11 10
Scrim
Scrim
1 1
1 1
1
1
2012
Y Y
3
2013
Y
1
1
1
1
4
2009
Y
1
1
1
1
5 6
2013 2010
Y
1 1
1 1
1
1
1
1
1
7
2012
Y
1
1
1
1
1
1
1
1
1
1
1
8
2012
Y
1
1
1
1
1
1
1
1
1
1
1
9 10
2013 2011
Y
1 1
1 1
1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
11
2010
Y
1
1
1
1
1
1
1
1
1
1
1
12
2011
Y
1
1
1
1
1
1
1
1
1
1 2
2011
Jane Doe
1
1
1
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Name of Coach Submitting completed Competition Record: Date:
126
Participation in outside competitions and on outside teams, while a member of an intercollegiate team at Ursuline College, can jeopardize a student-athlete’s eligibility. Prior written approval is required for any Ursuline College student-athlete to participate in any form of outside competition either during the academic year or summer. The following form must be filled out completely, signed and turned in to the Compliance Coordinator for approval no later than two weeks prior to any outside competition. STUDENT-ATHLETE NAME:
SPORT:
CELL PHONE:
E-MAIL:
APPROVAL TO:
Compete Unattached
Represent Institution
Represent Outside Team
DATE(S):
NAME OF OUTSIDE TEAM: EVENT NAME:
LOCATION:
TYPE OF EVENT: Please check below…
High School Alumnae/Alumni Game
Summer League
Officially Recognized State or National Multisport Event
Pan American Games Tryout or Competition
Olympic Games or Qualifier
US National Team
World or World Youth Championships, World University Games or World Cup Tryouts or Competition Other (Please describe): ____________________________________________________________________________ Are any expenses (transportation, lodging, meals, apparel, equipment, entry fees) being paid by anyone other than you or your parents or legal guardians? No Yes If Yes, by whom & what expenses:_______________________________________________________________________________ Will any class time be missed for these activities? _________________________________ Student-Athlete Signature
No
______________ Date
Yes
(If Yes, prior approval from professors is required)
_________________________________ Head Coach Signature
______________ Date
Compliance Office Use Only
Approved
Denied
REASON FOR DENIAL:
SIGNATURE OF COMPLIANCE COORDINATOR:
DATE:
127
