Please circle type of waiver.
	Core Course	Transcript Change	Disability Services
	Foreign Student	Home School	Grade-Point Average
WAIVER OF INITIAL ACADEMIC-ELIGIBILITY
REQUIREMENTS PURSUANT TO NCAA BYLAW 14.3
WAIVER APPLICATION
2001-02 Academic Year

This application must be completed in totality, and all required documentation must be submitted before the Division I Initial-Eligibility Waivers Committee or division II Academic Requirements Subcommittee on Initial-Eligibility Waivers may process the waiver request.  Please type or print.

1.	Applicant institution:      		Division (of sport):      	
2.	Student-athlete's name:      		
3.	Student-athlete's date of birth:      	 SS#:      	
4.	Student-athlete's status.
	Prospective student-athlete:      		Sport(s):      	
	Enrolled student-athlete:      		Sport(s):      	
	Date of high-school graduation:      	
	Date of initial-collegiate enrollment:      	
	Date of initial-collegiate enrollment at applicant institution, if different:      	
5.	Student-athlete's secondary credentials.  Please attach copies of the student-athlete's original secondary (domestic and/or foreign) credentials to this application.  Note:  The academic credentials necessary to satisfy the core-curriculum requirement(s) of a foreign student are specified in the NCAA Guide to International Academic Standards for Athletics Eligibility.

	Core-Course GPA:      		GPA calculation based on      	 core courses
	Total completed core courses:      		Overall GPA:      	
6.	Standardized examination information.
	National/accepted ACT/SAT score(s) and date(s) taken:      		     		     	
	Please attach copies of all official test results. Please include all national ACT and SAT examination results.
7.	Reason waiver is requested.
a. Bylaw 14.3 deficiency.
Please specify why the student-athlete does not meet the initial academic-eligibility requirements contained in Bylaw 14.3 (e.g., core-course deficiency, inadequate grade-point average).
     	

b. Special circumstances.
Please explain in detail the circumstances that precluded the student-athlete’s fulfillment of the initial academic-eligibility requirements specified in Bylaw 14.3.  Please attach to this application any supportive documentation the applicant wishes the subcommittee to consider regarding these circumstances (e.g., affidavits, letters of corroboration or explanation), including what measures the student-athlete took to meet the requirements.
     	

8.	Recruiting history.
	NCAA Bylaw 13.02.11 (Division I) and 13.02.09 (Division II) defines recruitment as "any solicitation of the prospect or the prospect's family (or guardian) by an institutional staff member or by a representative of the institution's athletics interests for the purpose of securing the prospect's enrollment and ultimate participation in the institution's intercollegiate athletics program."  Please answer the following questions and provide an explanation related to the recruitment of the student-athlete:

a. Date when recruitment of the student-athlete first occurred:      
b. Initiated or arranged telephone contact on more that one occasion for recruitment purposes. Yes      No     
Explain:      	
c. Arranged in-person, off-campus encounter	Yes      No     
Date:      	
d. Official visit:	Yes      No     
Date:      	
e. Date student-athlete signed financial aid agreement (e.g. National Letter of Intent), if applicable:
     	
f. Has the student-athlete been offered or received athletically related financial assistance per NCAA Bylaws 15.1.2 and 15.5.1.1?	Yes      No     
9.  Clearinghouse history.
a. Date student-athlete registered with the NCAA Initial-Eligibility Clearinghouse:      
b. Date student-athlete received preliminary Initial Eligibility Certification Report (Form 48-C) from the clearinghouse:      	
c.	Date student-athlete was placed on Institutional Request List (IRL)       
10.  When was Bylaw 14.3 first discussed with student-athlete?       

Have you included all required information?
(Waivers will not be processed until all information listed below has been received.)
	Final certification report (48-C) (except for students home schooled for entire high-school curriculum).
	Transcript(s) from all high schools attended by the student-athlete.
	All relevant 48-H confirmation forms. (Note: Foreign-student waivers do not require a 48-H form.)
	Did you circle waiver type on page No. 1?
Additional information also must be included for the following waivers:
Transcript Change
	High-school policy on grade/transcript changes.
	Report card or grade report from semester(s) in question.
	Copy of gradebook from course(s).
	Detailed explanation of circumstance surrounding the grade/transcript changes(s)
	Copies of all transcripts.
Home School
	List of completed core courses.
	Evidence of independent assessment (if applicable).
	Statement of compliance with state home-schooling requirements.
	List of textbooks used for all core courses.
	Name of the instructor(s) and the number of hours of individualized teacher-led instruction completed per day.
	copies of official SAT and/or ACT results.
Foreign Student
	Copies of Leaving or Senior Certificate (and translation).
	Translation of transcripts(s).
Disability Services
	Documentation listing all accommodations available at the high school, plus a list of which accommodations were used by the student.
	Written diagnosis, include IEP (diagnosis should indicate the specific measure and application of the diagnosis).
	Letter(s) of assessment/recommendations from student-athlete's high-school principal, guidance counselors and/or teachers.
	Student-athlete's own written comments.
Other documentation may be required by the Division I or II committee/subcommittee.

11.	Verification.

The application of a prospective or enrolled student-athlete must be signed by the student-athlete and by two of the following individuals of the involved institution (one of whom must be from outside of the athletics department): chief executive office or faculty athletics representative and director of athletics or senior woman administrator.

The undersigned understands that it is a violation of NCAA Bylaw 10.1 to knowingly furnish fraudulent academic credit, false transcripts or misleading information.

a.	Signature (institutional representative): 		Date: 	
	Name and title of institutional representative:  Dr. Maryalyce Jeremiah, Senior Associate Director of Athletics	
	Signature (institutional representative): 		Date: 	
	Name and title of institutional representative:  Dr. Lee Gilbert, Faculty Athletic Representative			
b.	Institutional contact person:  Dr. June Kearney			
	(Note: all correspondence regarding this waiver will be directed to the contact person.)
	Telephone number: 714-278-3431			
	Fax number: 714-278-5819			
	E-mail address: jkearney@fullerton.edu			
To be completed by student-athlete:

The undersigned understands that it is a violation of NCAA Bylaw 10.1 to knowingly furnish fraudulent academic credit, false transcripts of misleading information.

Buckley Statement.  You give your consent to disclose only to authorized representatives of this institution, its athletics conference (if any), your high school(s) and the NCAA, any documents or information pertaining to your NCAA eligibility.

Additionally, I give my consent to the NCAA to disclose personally identifiable information from my education records to a third party (including but not limited to the media) as necessary to correct any inaccuracies reported by the media or related to this waiver, without such disclosure constituting a violation of my rights under the Family Educational Rights and Privacy Act.

	Signature (student-athlete) 	 Date: 	
	Student-athlete's address: 			
	Date student-athlete first became aware of NCAA Bylaw 14.3 (the initial-eligibility requirements): 	

Within 72 hours (three working days) of receipt of waiver, the contact person will be notified via facsimile to confirm receipt of the waiver, whether information is missing and the name of the staff member handling the waiver.  Status reports are discouraged within the 72-hour period.