Eligibility Affidavit Form (Page 2 of 2) in pdf

(Page 2 - NJCAA Eligibility Affidavit Continued)

5. Have you ever participated in practices, scrimmages, and/or games for an intercollegiate team other than this

_____________

college? Yes _____ No _____ If yes, name the school, date, sport, and describe the situation.

______________________________________________________________________________

6. Have you ever played on a club team at a college or university? Yes _____ No _____ If yes, name the school,

_______________________________________________________________

sport and dates.

______________________________________________________________________________

7. Do you currently play on any other sport teams (i.e. USAV, city recreational leagues, indoor soccer, AAU, etc.)

Yes _____ No _____. If yes, please provide the name of team, location, and dates of participation.

_____________________________________________________________________________

8. Have you ever received money beyond expenses for participating in any athletic event? Yes _____ No _____

Did anyone on your team receive money beyond expenses for participating in any athletic event? Yes ____ No ____

If yes, describe the situation below and the NJCAA Amateurism Questionnaire should be completed and included

______________________________________________________________

with the eligibility file. _

______________________________________________________________________________

List ALL Colleges Attended Full-Time and/or Part-Time after High School

All transcripts from all previous institutions must be included.

________________________

_____________________

College:

Dates:

Full-time or Part-time?

(circle one)

________________________

_____________________

College:

Dates:

Full-time or Part-time?

(circle one)

________________________

_____________________

College:

Dates:

Full-time or Part-time?

(circle one)

________________________

_____________________

College:

Dates:

Full-time or Part-time?

(circle one)

Additional Explanations:

NOTE: If you attended college part-time or were not attending college for any period of time following high school

graduation, please document your employment and military history during those times in the space below. If you were

unemployed at any time, please list those dates below. The NJCAA requires that you account for any time not enrolled

_______________

full-time. Please use the space below. Please record months and years when referring to dates.

________________________________________________________________________________

I understand that information falsified or omitted can make me ineligible for ALL future college competition in

compliance with the National Junior College Athletic Association Eligibility Rules.

Student-Athlete Signature: ______________________________________________

Date: ______________________

Coach Signature: _____________________________________________________

Date: ______________________

309

Eligibility Affidavit Form Page 2

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