Form 200 - Transfer Rule - Middlesex/merrimack Valley Leagues' Waiver Committee - 2005

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MIAA
TEL: (508) 541-7997
33 Forge Parkway
FRANKLIN, MA 02038
FAX: (508) 541-9888
E-mail: miaa@miaa.net
Middlesex/Merrimack Valley Leagues’
Waiver Committee
THIS FORM MUST BE FULLY EXECUTED PRIOR TO PARTICIPATION
TRANSFER RULE ~ FORM 200
A.
The Receiving School Principal completes this section and then forwards to the Sending School Principal.
1.
Receiving Principal__________________________School_____________________Phone_______________
2. Student’s Name_______________________________ Grade________Date of enrollment________________
Student’s Address_________________________________________________Date of birth_______________
3. The student wishes to participate in the following sports:
Fall:____________________________________________________________
Winter:__________________________________________________________
Spring:__________________________________________________________
4.
Student’s reason for transfer:__________________________________________________________
B.
The Sending School Principal & Athletic Director complete this section & returns to Receiving School
Principal.
1. Sending Principal_________________________School_______________________Phone________________
2. List ALL athletic participation since first entering grade 9 (include level of play & school)
Grade 9
Grade 10
Grade 11
Grade 12
Fall:
School
Winter:
School
Spring:
School
3. The Sending School Principal and Athletic Director certify the following by initialing each:
a. To my knowledge, recruitment was not involved in any way:___________________________
b. At the time of transfer, the student was in good standing:______________________________
c. The student would be academically eligible at my school:______________________________
d. We have no knowledge that the transfer was for any reason related to athletics:_______________
e. The transfer student would be eligible at our school to participate in athletics:______________
f.
Comments:__________________________________________________________________
4. Sending School A.D.’s signature:________________________________________ Date_____________
5. Sending School Principal’s signature:_____________________________________ Date_____________
C. APPROVED
1. The Receiving School Principal certifies (ref. B,3, a-e) Transfer Rule eligibility on: ______/_____/_____
2. The student also is eligible under all other MIAA and local eligibility standards ________yes _______no
3. Receiving School Principal’s signature:_____________________________________Date:_____________
4. Receiving School A.D.’s signature:________________________________________ Date_____________
D. DENIED
1.
The Receiving School Principal does not certify(ref. B,3, a-e) Transfer Rule eligibility: _____/_____/_____
2. Receiving School Principal’s signature:_____________________________________Date:______________
3. Receiving School A.D.’s signature:________________________________________ Date_______________
DO NOT RETURN THIS FORM TO THE MIAA (unless applying for a waiver) – PLEASE RETAIN AT THE
RECEIVING SCHOOL.
Revised 9/28/05

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