Athlete Agent Registration Page 8
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9kansas secretary of state
AA
Athlete Agent Registration
81
Appendix F
Use additional sheets as necessary.
Please answer each of the following questions with regard to the applicant and each person identified in Appendix E. If any
question is answered yes, please provide a detailed explanation on a separate sheet.
1. Has the conduct of the applicant or any person identified in Appendix E resulted in
the imposition of a sanction, suspension or declaration of ineligibility of a student-
athlete or educational institution to participate in an interscholastic or intercollegiate
o
o
Yes
No
athletic event?
2. Has the applicant or any person identified in Appendix E ever been sanctioned,
suspended or disciplined as a result of occupational or professional conduct?
o
Yes
o
No
3. Has the applicant or any person identified in Appendix E ever had an athlete agent
application or renewal request denied?
o
o
Yes
No
4. Has the applicant or any person identified in Appendix E ever had an athlete agent
registration or license suspended or revoked?
o
Yes
o
No
5. Has the applicant or any person identified in Appendix E ever been convicted of a
felony, or of a misdemeanor involving moral turpitude?
o
o
Yes
No
6. Has the applicant or any person identified in Appendix E ever been administratively
or judicially determined to have made false, misleading, deceptive or fraudulent
o
o
Yes
No
representation?
I declare under penalty of perjury under the laws of the State of Kansas that the foregoing application is true and
correct.
Month
Day
Year
Signature of Applicant
X
7 / 8
Please continue to next page.
L. 2003, Ch. 109
Rev. 6/25/15 tc
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