Walk-On Certification Form printable pdf download

NCAA COMPLIANCE & STUDENT SERVICES

WALK-ON CERTIFICATION FORM

The head coach must initiate this form; that is, a prospective student-athlete's eligibility will not be established if s/he does

not present this form to the Office of NCAA Compliance & Student Services signed by the coach or his/her designee prior to

any participation in activities designated as practice per NCAA Bylaw 17.02.1

Print Name of Student:

Student Phone Number/Email:

UAlbany Number:

Sport:

Social Security #: _____ - _____ - _____

Date Admitted to UA: ___/___/___

Enrolled FT? Yes ___ No ___

Academic Status:

Freshman _____

UA Returnee Soph.

2-4 Transfer _____4-4 Transfer _____

Previous College(s) and Dates of Attendance: ___________________________ Did You Compete:

College and Date of Attendance:___________________________ Did You Compete:

Registered With the Eligibility Center:

Eligibility:

Qualifier / Nonqualifier

Student-Athlete Eligibility Affirmation: I affirm that I am enrolled in a full-time program of studies leading to a baccalaureate degree at the University at Albany; I am not

serving any university disciplinary probation or suspension; and, to the best of my knowledge, I am in good health and physically fit for competition. I agree to comply with all

rules and regulations of the NCAA, America East/Northeast Conference, and the University at Albany. I understand that I will not be allowed to participate in any practice or

competition activities until this form in completed in its entirety:

___________________________________________________

___________________________________

Student-Athlete Signature

Date signed

************************************************************************************

It has been determined that the above-named student is seeking permission to participate for your athletic team at

UAlbany. I am aware of this current student-athlete and allow she/he to practice with my athletic team:

_________________________________________________

___________________________________

Coach’s Signature

Date signed

UAlbany Athletic Training Eligibility Affirmation: The above-named student has completed all medical/physical

examination requirements, provided proof of personal health insurance, agreed to sickle cell test or signed off on waiver and

she/he is now medically cleared to participate:

_________________________________________________

___________________________________

Jay Geiger, Head Athletic Trainer (or designee)

Date signed

It has been determined that the above-named student has been accepted for admission to UAlbany and she/he is

enrolled in a minimum full-time program of studies at UAlbany.

___________________________________________________

___________________________________

Compliance Office

Date signed

************************************************************************************

Return this form to the Compliance Office, SEFCU 205 (Phone 442-3047).

You may not participate in any UAlbany-sponsored sport until you have completed NCAA, Conference, and institutional compliance paperwork,

and have been oriented on pertinent rules and regulations.

Provide copies of this completed form to: Athletic Training, Strength Staff, Academic Services, and your Head Coach.

NCAA COMPLIANCE OFFICE USE ONLY

NCAA Compliance forms completed:

The above-named student is approved for:

Yes ___ No ___

Date ___/___/___

Temporary practice: ____

Added to NCAA Squad List:

This student may not practice after the date

Yes ___ No ___

Date ___/___/___

___/___/___ by reason of ___________________

Walk-On Certification Form

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