Eligibility Affidavit Form printable pdf download

Eligibility Affidavit Form

NJCAA Eligibility Affidavit

______________________

_____________

SPORT:

Date:

1 or 2

Number Of Seasons Played

(Circle)

Fill in all applicable information on this form to assist in determining eligibility for the NJCAA.

Personal Information:

: ________________________________

: __/__/____

918- ____________

Name

Birth Date

ID Number:

(First, Middle, Last)

: ____________________________

________________________________

Student’s College Address

Street Address

City, State, Zip Code

Phone Number(s) at College: ________________________________

Email Address: _______________________

Other Information:

Parent’s Home Address

: ___________________________

_________________________________

Street Address

City, State, Zip Code

Parents’ Names: ________________________________

Phone Number: ________________________________

Foreign Born Students:

Do you have an I-20 Form on file at this college? Yes _____ No _____

High School Information:

: _________________________________________________

Name of High School(s) you have attended

: ________________________________________________________________

City, State & Country

__/___/____

Did you graduate?: Yes* _____ No _____

High School Graduation Date (month/date/year):

Were you home schooled? Yes _____ No _____

Did you graduate? Yes* _____ No _____

__/___/____

Check here if you have earned a *GED: ______

GED: Date Earned (month/date/year):

Did you attend three or more year of high school in the United States? ______ Yes _______ No

* Enclose a COPY of your High School Transcript, and GED Certificate (if applicable).

Additional Information:

1. Did you take any college credit classes while in high school? Yes* _____ No _____

_________________________________________________________

* If yes, from what college(s)?

* If yes, those transcript(s) from each college must be on file at this college.

2. Have you ever signed a Letter of Intent form with any institution? Yes _____ No _____

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

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

Sport(s)? _______________________

Country: ________________________

Dates: ___________________

If yes, describe the situation: ______________________________________________________________________

______________________________________________________________________________

4. Have you ever been red-shirted for a season? Yes _____ No _____

________________________

If yes, list the dates of that season, name of college, and describe the situation.

______________________________________________________________________________

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Eligibility Affidavit Form

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