Form must be filled out completely to be eligible for entry.

A. Will you have the use of or access to (regardless of ownership) any vehicle during the next year?
Yes      No (If no, go to Certification section at bottom of page)

Vehicle Description:
Year      Make      Model      Color 
State of Registration: 
License Plate Number: 
Name on the Title: 

Information Regarding Purchase:
Date of purchase 

B. Did someone other than a family member assist in the purchase or financing this vehicle? Yes      No
If yes, please identify the individual and their relationship to you: 
Was any University of Houston coach, staff member or booster involved in the purchase? Yes      No
If yes, please:
(1) Identify that individual: 
(2) Describe their involvement: 

Insurance:
Is your vehicle insured? Yes      No
It is illegal to operate an automobile in the state of Texas without insurance - This process cannot be completed without this information.
C. Is someone other than you paying the insurance premiums? Yes      No
If no, list the fund source utilized for insurance premiums

If yes, Identify the individual paying the insurance premiums 
Describe relationship of individual to you 

Certification
By entering my name below I certify the information I have provided is accurate to the best of my knowledge, and I agree to update the Office of Athletics Compliance should any of this information I have submitted change.