Clark Atlanta University Department of Athletics Student-Athlete Compliance and Rules Education Review

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Clark Atlanta University Department of Athletics Student-Athlete Compliance and Rules Education Review PERSONAL (Please print legibly) Today’s Date__________________ Name__________________________________________Date of Birth_____/_________/_______ 900#_______________________ Last First MI Sport(s)_____________________________________ Class: [FR] [SO] [JR] [SR] [GRD] Major_________________________ (Please Circle) Mother’s Name______________________________________ Father’s Name____________________________________________ Mother’s Address____________________________________ Father’s Address__________________________________________ City________________________ State_______Zip__________ City_______________________ State_______Zip______________ Mother’s Phone: Work ( )_____________________________Father’s Phone: Work ( )__________________________________ Home( )______________________ Home ( )___________________________ School Address________________________________________________ Telephone Number________________________________ (Name of Residence Hall, if off-campus, number and name of street, apartment number) Do you reside with both Parents? YES NO If no, which parent do you reside_____________________ Email address_____________________________________________________________ (CAU, AOL, hotmail, yahoo, etc.) HOUSING DURING SUMMER 1. Was your summer residence your permanent address/family home? Yes No If NO, or you lived any place other than your permanent/family home for any period during the summer please provide the information requested in the box below: Summer Address: Number and Street_________________________________________________________ Apt Number___________ City_________________________ State_____________________ Zip________________ Phone________________ Roommates Names (if any)_______________________________ ________________________________________ Was any member of the athletics department staff, coaches, or a booster involved in any way in helping you obtain this place to live? _____YES ______NO If YES, Who?_________________________________________ HIGH SCHOOL(S) AND/OR PREP SCHOOL(S) ATTENDANCE 1. Did you graduate from high school? YES NO 2. Were you born in a country other than the United States? YES NO 3. Did you attend any high school in a country other than the United States? YES NO 4. Please fill out this information: Last High School Attended Date of Graduation High School Location (City, State) Month Year COLLEGE OR JUNIOR COLLEGE ATTENDANCE 1. Date first entered Clark Atlanta University: ____________/_____________ Month Year 2. Date of first full-time attendance at any college/university: _____________/_____________ Month Year 3. Did you attend another college or junior college full-time other than Clark Atlanta University? YES NO If YES, please provide the information requested in the box below: Name of Institution(s) Date of Attendance Please Check (X) as Appropriate 1. ___________________________ _______________ ___2-year college ____4-year college 2. __________________________ _______________ ___2-year college ____4-year college Did you participate in athletics while enrolled? __YES ____NO/ If YES, at which institution____________________ Did you receive an athletic scholarship? ____YES ____NO/ If YES, at which institution____________________ Date of graduation from junior college________/_________ ______ Check if Not Applicable Month Year ATHLETIC PARTICIPATION: 1. Did your coach recruit you? _____Yes ______, IF YES, which coach recruited you?__________________ 2. Have you participated on any intercollegiate athletic teams during your college or junior college attendance not including this year? _______YES ________NO If YES, please provide the information requested below: Intercollegiate Academic /Competition History Did You Practice Did You Compete School Year Institution Sport(s) YES NO YES NO 2016-17_____________________________________________________________________ Y N Y N 2015-16______________________________________________________________________ Y N Y N 2014-15______________________________________________________________________ Y N Y N 2013-14______________________________________________________________________ Y N Y N 2012-13______________________________________________________________________ Y N Y N Indicate any “redshirt” year, US military service time , religious mission periods, study abroad and hardship waivers FINANCIAL STATEMENT 1. Do you have a type of loan for school this year? _____YES _____NO ______Unknown If YES, please provide the information requested below: Amount $______________ _____Unknown Source or Type_______________________________________ Do you have a co-signer? _____ YES ______NO If YES, name of co-signer_______________________ Amount $______________ _____Unknown Source or Type_______________________________________ Do you have a co-signer? _____ YES ______NO If YES, name of co-signer_______________________ Amount $______________ _____Unknown Source or Type_______________________________________ Do you have a co-signer? _____ YES ______NO If YES, name of co-signer_______________________ EMPLOYMENT REVIEW Did you have a job this past summer? _____YES ______NO: If YES, please provide the information requested below: Location (City & State)___________________________ Job Title___________________________________________ Employer__________________________________ Dates of Employment: Start___________ End________________ Did a member of the athletics department staff, coaches, or a booster involved in any way in helping you obtain this job? ______YES _____NO If YES, Who?_________________________________________ TRAVEL TO CAMPUS 1. Date of Arrival_________________ Means of Transportation__________________________________________ Private Car ( If so, whose) airline, train, bus, etc.) 2. Who traveled with you to campus? ___________________ ____________________ __________________ 3. Who paid for your travel expenses?___________________ MOTOR VEHICLE INFORMATION 1. Do you have a motor vehicle (car, truck, motorcycle, scooter, etc.) Available for you to use at school this year? ______YES ______NO If YES, please provide the information requested in the box below: Year_____________ Make_________________ Model____________________ License Plate #___________________ Registered to __________________Who purchased the vehicle (Indicate Relationship)?_______________________ AMATEURISM / EXTRA BENEFITS 1. Do you have an agent for professional sports ______YES ______NO. If YES, in what sport?_______________ 2. Have you ever received any type of pay for play, either directly or indirectly? ______YES ______NO 3. Has any member of your family been paid money, borrowed money, or received any other benefit of any kind from a professional team, league, agent, runner, financial advisor or agency? _____YES _______NO 4. Have you ever agreed, either verbally or in writing, to sign with or be represented by any professional team, League, financial advisor, agent, runner, or agency? _____YES _______NO CERTIFICATION OF COMPLIANCE 1. I understand that while participating in intercollegiate athletics at Clark Atlanta University, I must be enrolled (and making academic progress) in a minimum of 12 semester hours of academic credit per semester and can not drop below these hours at any time during the semester. 2. I certify that I have previously read, understand, and have had the opportunity to ask questions about regulations concerning extra benefits and the principles of amateurism and of ethical conduct governing Student-athletes attending NCAA Division II schools and agree to abide by them. I certify to the best of my knowledge, I understand that it is my responsibility to report any violations under NCAA rules of which I am aware and understand that providing false or misleading information may jeopardize my eligibility for practice, competition. 3. I certify that I attended a _________________ Student-Athlete Compliance & Rules Education Review meeting Date Academic Year conducted by the Department of Athletics and was given an opportunity to ask questions. 4. I certify that to the best of my knowledge all information that I have provided on this information sheet is accurate and true. I understand that my answers to the questions are continuing representations, and that I am responsible for updating the data during my enrollment at Clark Atlanta University. If any of my answers, although true now, would no longer be true because of subsequent occurrences, I agree to advise my coach and the Compliance Coordinator immediately. _________________________________________ Print Name ___________________________________________________ _________________________________________ ___________________ Student-Athlete’s Signature Sport (s) Date **** DO NOT WRITE BELOW THIS LINE **** Was the student-athlete recruited per NCAA Bylaw 13.02.9? _____YES ______NO Reviewed by: _____________________________________ _____________________________________________ Head Coach’s Signature Designated Administrator’s Signature Page Directory: sidearm.sites sidearm.sites -> Sunyac official Men’s Ice Hockey Roster suny potsdam Bears sidearm.sites -> Draft not for release sidearm.sites -> For Release: Thursday, June 1 – 12 noon et sidearm.sites -> Football bowl association schedule date Game Teams Time [ET]/TV sidearm.sites -> 2017 Cairn Highlanders Men’s Soccer No. Name Cl. 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