Form 530 - Student Sports Participation / Current Or Previous School Year Page 2

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STUDENT SPORTS PARTICIPATION / CURRENT OR PREVIOUS SCHOOL YEAR – FORM 530
NAME OF STUDENT__________________________________________
SENDING SCHOOL(s) – COMPLETE STATEMENT “A” OR “B” BELOW:
(attach additional sheet if needed)
A. If student did not compete in any sport at any level the previous year (i.e., freshman, junior varsity, varsity), sign
below:
_______________________________
_______________________________
_________________________
(Sending School)
(Responsible School Administrator)
(Date)
- OR -
B. If student competed in any sport, at any level, responsible school administrator of sending school shall indicate sports
in which student competed in interscholastic competition during the previous 12 months.
INDICATE EACH SPORT / ACTITIVY IN WHICH STUDENT COMPETED – AT ANY LEVEL:
(
)
Badminton
(
)
Golf
(
)
Swimming
(
)
Baseball
(
)
Tennis
(
)
Basketball
(
)
Soccer
(
)
Track
(
)
Chess
(
)
Softball
(
)
Volleyball
(
)
Cross Country
(
)
Speech & Debate & Theatre
(
)
Wrestling
(
)
Football
(
)
Spirit line
(
)
J.R.O.T.C.
------------------------------------------------------------------------------------------------------------------------------------------------------------------
STATEMENT OF SENDING SCHOOL:
The above information is correct to the best of my knowledge. I do ( ) do not ( ) believe that undue influence was used
to encourage the student to transfer.
(If answer is affirmative, explain and attach detailed information and
documentation.)
_______________________________
_______________________________
_________________________
(Sending School)
(Responsible School Administrator)
(Date)
CERTIFICATION OF STUDENT:
This is to certify that no school administrator, athletic coach or employee of a high school district has engaged in recruiting
of the student either by direct contact or indirectly through his/her parent(s), legal guardian(s), common school employees,
directors of summer athletic programs or other persons who are in a position to influence the choice of a school. We
further certify that a Form 530 has not been processed within the last 12 months.
____________________________________
______________________________________
(Signature of Parent/Legal Guardian)
(Signature of Student)
____________________________________
______________________________________
(Date)
(Date)
FORM 530
6/14
Page 2 of 2

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