This form has seven parts:

• A statement concerning eligibility;
• A Buckley Amendment consent;
• An affirmation of status as an amateur athlete;
• A statement concerning the promotion of NCAA championships and other NCAA events;
• Results of drug tests;
• Previous involvement in NCAA rules violation(s); and
• An affirmation of valid and accurate information provided to the NCAA Eligibility Center and admissions office, including ACT or SAT scores, high school attendance, completion of coursework and high school grades.

Before you complete this form, you should read the Summary of NCAA Regulations, and/or another outline or summary of NCAA legislation, provided by your director of athletics or his or her designee or read the bylaws of the NCAA Division I Manual that deal with your eligibility. If you have any questions, you should discuss them with your director of athletics or your institution's compliance officer, or you may contact the NCAA at 317/917-6222.

The conditions that you must meet to be eligible and the requirement that you complete this form are indicated in the following bylaws of the Division I Manual:

• Bylaws 10, 12, 13, 14, 15, 16, 18.4 and 31.2.3

Part I: Statement Concerning Eligibility.

By completing this part of the form, you affirm that, to the best of your knowledge, you are eligible to compete in intercollegiate competition.

You affirm that your institution has provided you a copy of the Summary of NCAA Regulations, and/or another outline or summary of NCAA legislation, or the relevant sections of the Division I Manual and that your director of athletics (or his or her designee) gave you the opportunity to ask questions about them.

You affirm that you meet the NCAA regulations for student-athletes regarding eligibility, recruitment, financial aid, amateur status and involvement in gambling activities.

You affirm that all information provided to the NCAA, the Eligibility Center and the institution's admissions office is accurate and valid, including ACT or SAT scores, high school attendance, completion of coursework and high school grades, as well as your amateur status.

You affirm that you have reported to the director of athletics or his or her designee of your institution any violations of NCAA regulations involving you and your institution.

You affirm that you understand that if you complete this statement falsely or erroneously, you violate NCAA legislation on ethical conduct and you will further jeopardize your eligibility.

Part II: Buckley Amendment Consent.

By completing this part of the form, you certify that you agree to disclose your educational records.

You understand that this entire form and the results of any NCAA drug test you may take are part of your educational records. These records are protected by the Family Educational Rights and Privacy Act of 1974 and they may not be disclosed without your consent.

You give your consent to disclose only to authorized representatives of this institution, its athletics conference (if any) and the NCAA, except as permitted in the Drug-Testing Consent form, the following documents:

• This form;
• Results of NCAA drug tests and related information and correspondence;
• Results of positive drug tests done by non-NCAA national or international athletics organizations;
• Any transcript from your high school, this institution, or any junior college or any other four-year institutions you have attended;
• Precollege test scores, appropriately related information and correspondence (e.g., testing sites, dates and letters of test-score certification or appeal), and where applicable, information relating to eligibility for or conduct of nonstandard testing;
• Graduation status;
• Your social security number and/or student identification number;
• Race and gender identification;
• Diagnosis of any education-impact disabilities;
• Accommodations provided or approved and other information related to any education-impact disabilities in all secondary and postsecondary schools;
• Records concerning your financial aid; and
• Any other papers or information pertaining to your NCAA eligibility.

You also agree that information regarding any infractions matter in which you may be involved may be published or distributed to third parties as required by NCAA policies, bylaws or procedures.

Part III: Affirmation of Status as an Amateur Athlete.

You affirm that you have read and understand the NCAA amateurism rules.

By completing this part of the form, you affirm that, to the best of your knowledge, you have not violated any amateurism rules since you requested a final certification from the Eligibility Center or since the last time you completed a Division I student-athlete statement, whichever occurred later.

You affirm that since requesting a final certification from the Eligibility Center, you have not provided false or misleading information concerning your amateur status to the NCAA, the Eligibility Center and the institution's athletics department, including administrative personnel and the coaching staff.

Promotion of NCAA Championships, Events, Activities or Programs.

You authorize the NCAA [or a third party acting on behalf of the NCAA (e.g., host institution, conference, local organizing committee)] to use your name or picture to generally promote NCAA championships or other NCAA events, activities or programs.

Part V: Results of Drug Tests.

1. Future positive test - ALL STUDENT-ATHLETES SIGN.

Should I test positive for a substance banned by the NCAA and/or by a non-NCAA national or international sports governing body; violate their drug-testing protocol; or fail to show for their drug test, at any time after I complete this statement, I acknowledge I must report the results to my director of athletics.

2. Positive test by NCAA or other sports governing body - SIGN EITHER A OR B

A. No positive drug test.
I affirm that I have never tested positive for a substance banned by the NCAA and/or by a non-NCAA national or international sports governing body; or violated their drug-testing protocol; or failed to show for their drug test.

B. Positive drug test.

I have tested positive for a substance banned by the NCAA and/or by a non-NCAA national or international sports governing body; or violated their drug-testing protocol; or failed to show for their drug test. Should I consequently transfer, I am obligated to report this to the transferring institution.

Part VI: Incoming Transfers - Previous Involvement in NCAA Rules Violation(s)

Have you previously attended a four-year NCAA Division I, II or III institution?

Yes, I am an Incoming Transfer Student
No, I am an Incoming Freshman
No, I am a returning Student-Athlete or other

If yes, what is the name(s) of the institution(s)?

Are you aware of any NCAA violations you were involved in while previously attending an NCAA institution?

Yes   No

If yes, did this violation result in your being withheld from competition while attending your previous institution? (Yes or No)

If you answered yes to either of the above questions, please provide an explanation.

Part VII: Incoming Freshmen - Affirmation of Valid ACT or SAT Score

You affirm that, to the best of your knowledge, you have received a validated ACT and/or SAT score. You agree that, in the event you are or have been notified by ACT or SAT of the possibility of an invalidated test score, you will immediately notify the director of athletics of your institution. You affirm that all information provided to the NCAA, the Eligibility Center and institution's admissions office is valid and accurate, including high school attendance, completion of coursework and high school grades. You affirm that you did not fraudulently earn your qualifying ACT or SAT score by having someone else take the test for you, copying answers from another person taking the test, etc.