Ossaa Eligibility Record Form For Students In Grades 7-12

OSSAA ELIGIBILITY RECORD FORM FOR STUDENTS IN GRADES 7-12

Updated July 2013

(TO BE FILLED OUT BY THE STUDENT AND PARENT AND FILED IN PRINCIPAL'S OFFICE)

NAME OF STUDENT (PRINT) ______________________________________________ Grade ______ Birth date ______________________ Age ____________

Student’s Current Address_______________________________________________________________________________________________________________

Last School attended __________________________________ Last School Address _________________________________________________ Zip___________

NOTE: STUDENT AND PARENT MUST SIGN BELOW AND EXPLAIN ALL “YES” ANSWERS FROM BELOW ON BACK OF FORM.

YES NO

1. Before September 1 will you be 14 years of age for 7th grade, 15 years of age for eighth grade, 16 years of age for ninth grade, or

19 years of age for high school participation ? (Rule 1)

2. Have you missed school more than 10% of the school days taught for this 18-week grading period? (Rule 2)

3. Did you fail any classes during the last 18-week grading period? (Rule 3 & 4)

4. Are you currently failing any class? (Rule 3)

5. Were you ineligible to participate at any time during the last 18-week grading period? (Rules 3 & 4)

6. Have you done anything to jeopardize your amateur status such as receiving cash or merchandise connected with an athletic

activity? (Rule 5)

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7. Have you completed all 12

grade requirements for high school graduation? (Rule 6)

8. Have you failed any semesters (received no credit for the semester) since the time you entered the 7th grade? (Student’s are generally

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lmited to participating in athletics during the 7

grade and the five school years that follow consecutively after that school year-

Rule 7)

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9. Since entering 7

grade have you ever home-schooled or had an interruption in consecutive semesters of the educational tract?

10. Are you now or have you ever repeated any grade since entering the 7th grade? (Rule 7)

11. Do you live with someone now other than whom you lived with last school year? (Rule 8)

12. Do you live with someone other than your parents? (Rule 8)

13. Do you live with only one parent? (Rule 8)

14. Do you live outside this school district? (Rule 8)

15. Is more than one residence owned, rented or maintained by your parents or guardian? (Rule 8)

16. Have you ever attended school outside the district where your parents reside? (Rule 8)

17. Are there other family members in grades K-12 attending a different school district other than the district you are now attending?

18. Have you ever participated at any school outside the district in which both parents had residence? (Rule 8)

19. Have you, your parents, or your guardians ever been influenced in any manner by anyone in this school district to attend this school

to engage in athletics? (Rule 9)

20. Have you ever been granted athletic eligibility on the basis of an OSSAA hardship waiver? (Rule 20)

21. Were you on an approved foreign exchange program last year? (Hardship Waiver Manual-X)

22. Have you participated in a foreign exchange program for more than 365 days? (Hardship Waiver Manual-X)

23. Were you suspended, expelled, or under discipline at the previous school attended, or were you or your parents having a conflict

with a coach, teacher, or administrator at the time you left your previous school? (Rule 4 and 8)

Each   o f   t he   u ndersigned   a lso   a cknowledge   a nd   a gree   t hat   i dentifying   i nformation   a bout   t he   a bove-­‐mentioned   s tudent   m ay   b e   d isclosed   t o  

OSSAA   i n   c onnection   w ith   a ny   i nvestigation   o r   i nquiry   c oncerning   t he   s tudent’s   e ligibility   t o   p articipate   a nd/or   a ny   p ossible   v iolation   o f  

OSSAA   r ules.     O SSAA   w ill   u ndertake   r easonable   m easures   t o   m aintain   t he   c onfidentiality   o f   s uch   i dentifying   i nformation,   p rovided   t hat   s uch  

information   h as   n ot   o therwise   b een   p ublicly   d isclosed   i n   s ome   m anner.  

If the above guidelines are not satisfied for athletic eligibility, the student may be ineligible for one year. (See Rule 8)

INCORRECT INFORMATION COULD CAUSE ELIGIBILITY TO BE REVOKED AND COULD RESULT IN THE

FORFEITURE OF CONTESTS IN WHICH THE STUDENT HAS PARTICIPATED IN ADDITION TO OTHER PENALTIES.

__________________________________________________

_______________________________________________

(Student)

(Date)

(Coach)

(Date)

__________________________________________________

(Parent/Guardian)

(Date)