Piaa Member School Request For Decision On Athletic Eligibility Form
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2PENNSYLVANIA INTERSCHOLASTIC ATHLETIC ASSOCIATION, INC. (PIAA)
MEMBER SCHOOL REQUEST FOR DECISION
ON ATHLETIC ELIGIBILITY FORM
(Revised July 1, 2010)
(PLEASE PRINT OR TYPE)
DATE: ________________
SECTION 1. MEMBER SCHOOL INFORMATION
A. Full Name of Principal:
B. Member School:
C. Member School Address:
D. Member School Phone No.: (
)___________________ Member School Fax No.: (
)___________________
SECTION 2. STUDENT INFORMATION
A. Full Name of Student:
Grade
(First)
(Middle)
(Last)
B. Place of Residence:
(Street Address)
(City)
(State)
(Zip Code)
C. Name(s) of the head of household in which the student resides:
Relationship to the student:
D. Residence is located within the boundaries of the_____________________________________ Public School District
E. Date of Student’s Birth: ________/_________/_______
F. Age of Student on Last Birthday: ____________
G. Date Student Enrolled for the Current School Year: _________/_________/_________
H. Summary of Student’s School(s) Attended and Sport Participation in Each Season:
SCHOOL
LIST SPORT PARTICIPATION IN EACH SEASON
GRADE
YEAR
SCHOOL ATTENDED
FALL
WINTER
SPRING
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SECTION 3. SPECIFICATION OF ARTICLE AND SECTION OF PIAA BY-LAWS
A. This case relates to the following ARTICLE and Section of the PIAA By-Laws
ARTICLE I
- AGE - Section _____
ARTICLE II
- AMATEUR STATUS AND AWARDS - Section _____
ARTICLE III
- ATTENDANCE - Section _____
ARTICLE IV
- CONSENT OF PARENT OR GUARDIAN - Section _____
ARTICLE V
- HEALTH - Section _____
ARTICLE VI
- TRANSFERS, RESIDENCE, AND RECRUITING - Section _____
ARTICLE VII - FOREIGN EXCHANGE STUDENTS, INTERNATIONAL STUDENTS,
AND FOREIGN STUDENTS - Section_____
ARTICLE VIII - PERIOD OF PARTICIPATION - Section _____
ARTICLE IX
- REPRESENTATION - Section _____
ARTICLE X
- CURRICULUM - Section _____
ARTICLE XI
- ASSUMED NAME
ARTICLE XVI - SEASON AND OUT-OF-SEASON RULES AND REGULATIONS - Section _____
ARTICLE XIX - JUNIOR HIGH/MIDDLE SCHOOLS - Section _____
(please turn page over)
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