Student - Athlete Data Sheet& Athletic Eligibility Form
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1
2STUDENT NAME __________________________________________________________
Phone: _________________________________
Date: ________________
(Please Print) Last Name
First Name
Sport:______________________________ Boys
Girls
School: __________________________________________
ID # ______________________
STUDENT – ATHLETE
DATA SHEET& ATHLETIC ELIGIBILITY
WESTERVILLE CITY SCHOOLS & OHIO HIGH SCHOOL ATHLETIC ASSOCIATION
FOREIGN EXCHANGE STUDENTS ONLY
Parent/Guardian Names __________________________________________________________
Y
N
Are you a foreign exchange student?
Address _______________________________________________________________________
Y
N
Are you a returning foreign exchange student?
City
State
Zip
AGE REQUIREMENTS OF THE STUDENT ATHLETE
Have you graduated from high school in your native country?
Y
N
ELIGIBILITY FOR INTERCOLLEGIATE ATHLETICS
Present Age _________
Date of Birth _____________
Gender: M
F
Are you aware that both the NCAA and the NAIA have eligibility requirements and
Y
N
th
Grade _________
In what year did you enter 9
Grade? ___________________
recruiting rules for incoming freshman based upon their high school academic record?
If you do not understand this, please contact your coach.
RESIDENCE REQUIREMENTS
INJURIES
Are your natural parents divorced?
Y
N
Do you understand that you must immediately report all injuries either to your coach or
Y
N
athletic trainer?
If yes, are you residing with the custodial parent?
Y
N
ACADEMIC ELIGIBILITY REQUIREMENTS
Does your custodial parent or guardian reside within the Westerville School District?
(Reside means eat, sleep, maintain voting record, receive mail and spend the majority of
Y
N
In order to be eligible to participate in interscholastic athletics, you must have passed 5
Y
N
non-work time.)
courses at one unit (not including physical education) during the preceding nine weeks.
Are you an independent (emancipated) student?
Did you accomplish this?
Y
N
(Emancipated means a student who is not living in the same school district as his/her
Y
N
Did you receive at least a 1.75 GPA during the preceding nine weeks?
parents and is financially self-supporting.)
FRESHMAN ONLY
Will you become an independent (emancipated) student this year?
Y
N
First quarter freshman must have passed five (5) of their classes during the last nine weeks
ENROLLMENT REQUIREMENTS
period in middle school.
Y
N
Y
N
th
Did you enroll in school after the 15
day of the school year?
Did you accomplish this?
Y
N
Have you practiced, scrimmaged or played as a part of another team from another school
VERIFICATION
during the current school year?
Are you a transfer from either of the other two Westerville City Schools high schools?
Y
N
NOTE: ANY CHANGES THAT OCCUR IN-SEASON MAY AFFECT ELIGIBILITY
(RESIDENCY, CUSTODY, ETC.). IF CHANGES OCCUR, PLEASE NOTIFY THE ATHLETIC
Have you attended another public or private high school?
Y
N
DIRECTOR IMMEDIATELY. TO THE BEST OF MY KNOWLEDGE, THE ABOVE
INFORMAITON IS CORRECT. I UNDERSTAND THAT IF I FALSIFY INFORMATION OR
Have you ever withdrawn from either of the other two Westerville City Schools high
Y
N
FAIL TO REPORT ANY CHANGES, IT COULD CAUSE ME TO BE INELIGIBLE, AND IT COULD
schools? If yes, Which high school(s)? ________________
CAUSE MY TEAM TO FORFEIT CONTESTS.
Have you graduated from high school?
Y
N
STUDENT SIGNATURE _____________________________________
DATE: _________
Where you born in a country outside of the United States of America?
PARENT SIGNATURE ______________________________________
DATE: _________
Name of Birth Country ________________________________________
Y
N
Revised 6/29/11
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