Form 04-10a                                              		       Academic Year 2004-05

			    General Amateurism and Eligibility Form for International 
                   and Select Student-Athletes  Division I            
					
For:	NCAA Division I institutions.	
Action:	Complete for each international student-athlete and file at your institution with other eligibility documents.	
Due date:	The student-athlete’s first day of practice or outside competition.	
Required by:		NCAA Bylaw 14.5.1.	
Purpose:	To qualify international student-athletes for intercollegiate practice or competition and assess compliance with NCAA general amateurism and eligibility rules.	

Part I:  Institutional Guidelines.

To be eligible to represent an institution in intercollegiate athletics practice or competition, an international/select student-athlete shall be certified as eligible using this form.  An international/select student-athlete is a student-athlete who either (a) is not a United States citizen, or (b) resides in an unincorporated or commonwealth territory of the United States, or (c) has participated in foreign athletics activities or was associated as an athlete with a foreign athletics organization. 

Each international/select student-athlete who is participating for the first time in intercollegiate athletics at the certifying institution should be given this form to complete and to sign.  The form should be completed in the presence of the institution's eligibility-certification official.  It may be necessary for an institutional administrator to assist the student-athlete in understanding terms and to ensure that the student-athlete responds to all items.  Subsequent to the student-athlete completing the form, the institution's eligibility official is responsible for investigating any answers that may result in ineligibility.  Further, the statement must be signed by the institution's eligibility official and the student-athlete's head coach prior to the student-athlete engaging in competition.  The completed form shall be maintained on file at the institution with other eligibility documents.  (See Bylaw 14.5.1.)

Please be aware that your institution is responsible for:

•	Reviewing Bylaw 10.1 with the student-athlete to ensure that all information is provided truthfully and that the student-athlete is aware that further eligibility consequences could result if false and misleading information is provided.  

•	Verifying the validity of the information provided by the student-athlete.

•	Analyzing the information submitted by the student-athlete and applying general amateurism and eligibility rules, particularly those related to amateurism, to determine the student-athlete's general eligibility.  (NCAA Division I Manual citations are included after each item to assist in this effort.)

•	Contacting the NCAA membership services staff for assistance in determining the correct application of NCAA rules.

•	Advising the student-athlete that the information being provided through this form can affect the individual's eligibility.

[Note:  International/Select student-athletes also must sign the NCAA student-athlete statement, NCAA affirmation of eligibility and NCAA drug-testing consent form.]

Part II – International/Select Student-Athlete Information.

[Please note that this section is to be completed by the student-athlete.]

To be eligible for intercollegiate athletics practice and competition, every student-athlete must meet all applicable NCAA eligibility requirements.  As an international/select student-athlete, you are required to complete this form so that your institution may determine your eligibility under NCAA rules.  You must fully disclose all information relative to the questions asked in order to determine your eligibility.

This questionnaire does not relate to your admission to the school – the admissions office of your institution will handle that process separately.

You must respond to each item below and sign the form to compete in intercollegiate athletics at an NCAA institution.  (Use "N/A" if the question does not apply to you.)  Ask an administrator at your institution for help if you do not understand an item.  (References to NCAA Bylaws that follow each item are for your institution's use.)  The institution's eligibility-certification official and your head coach also must sign the completed form and keep it on file at the institution with other eligibility documents.

Please note that the information you provide on this form will be used to certify your eligibility and thus may impact your eligibility to compete at an NCAA institution.  In addition, under NCAA legislation you are required to provide accurate information.  If you knowingly provide false and misleading information on this form it may result in additional consequences to your NCAA eligibility.

[Note:  In completing the following items, please use the back of the pages if you need additional space.]

A.	General Information.	
	Full Name:		Sport(s):		
	Other possible spellings of your name:		

	Date of Birth:	/	/			
		Month	Day	Year		
	Home Country:  ______________________________	
	Government Identification Number:		
	[Note:  This is similar to the United States Social Security Number.]	

B.	Educational Background.	
	Please list all schools attended (e.g., high schools, preparatory schools, secondary schools, etc.).	
	Year	School	Country	Tuition Required & Amount	Degree Received	Graduation Date	

							

1.	For all schools where tuition was required, please indicate who paid for your expenses (e.g., parents, coach, school, athletics team, government, family friend, other individual, etc.)  [Bylaw 12.1.1.1.3]  

SCHOOL		TUITION PAID BY	

			

2.	Did you attend any classes beyond high school?
(Please circle)      YES       NO         I DON’T KNOW
If yes, please provide the name of the school(s) and the years attended.  [Bylaw 14.2.1]

SCHOOL		YEARS ATTENDED	

			

C.	Participation in Athletics.	
	1.	Date of birth:			Age:		
		Please list all athletics activities that you have participated in after your 21st birthday.  [Bylaw 14.2.3.5]	
	ACTIVITY		DATES OF PARTICIPATION	

				

	2.	To be completed by tennis student-athletes only.	
		Date of High-School Graduation:		
		Please list all tennis tournaments you competed in after graduating from high-school.  [Bylaw 14.2.3.2]	
		TOURNAMENT/EVENT		YEAR	

					

3.	Participation on an organized team.
Please list all organized teams you have participated on, include the dates participated and all expenses received. 

TEAM AND LEAGUE

	DATES
PLAYED	MEALS AND
LODGING 
RECEIVED 	TRAVEL AND
TRANSPORTATION
EXPENSES RECEIVED	OTHER
EXPENSES
RECEIVED	

					

					

					

					

					

a.	Did you get paid for your participation on any of the teams mentioned in Section No. 3?  [Bylaw 12.1.1]		YES     NO

b.	Were any members of your team paid (e.g. salary)?  [Bylaw 12.2.3.2]
YES     NO         I DON’T KNOW

If yes please indicate which team paid its members.

	

c.	Did you sign any type of agreement to participate on any of the teams mentioned in Section No. 3?  [Bylaw 12.1.1]	YES     NO

If yes, for which team and please provide a copy of the agreement signed.

	

d.	Did any of the teams you participated on call themselves a professional team?  [Bylaw 12.02.4]		YES	NO    I DON’T KNOW

If yes, which ones.

	

4.	Additional issues.

a.	Have you ever accepted any prize money for your participation in athletics:  [Bylaws 12.1.1.1.5 and 12.1.1.4]

If yes, how much prize money did you receive?  _____________________	
If yes, what were your actual and necessary expenses directly related to the competition?  _______________________________________________	

b.	Have you accepted any other items not listed on this form from individuals other than your parents or legal guardians?  [Bylaw 12.1.1.1.6]
YES     NO      I DON’T KNOW

c.	Have you ever been involved in an advertisement or promotional activity?  [Bylaws 12.1.1 and 12.5.1]	YES     NO     I DON’T KNOW
  
If yes, please list the activities.

	

d.	Have you ever accepted any money or items of any kind for your participation in an advertisement or promotional activity?  [Bylaws 12.1.1 and 12.5.1]		YES     NO

e.	Did you or someone on your behalf ever pay a recruiting service or another individual to assist you in finding an institution or obtaining an athletics scholarship?  [Bylaw 12.3.3.1]		YES     NO     I DON’T KNOW

f.	Who paid for your transportation to the United States?

g.	When did you first arrive in the United States?

h.	Where did you live once you arrived in the United States?

i.	Did you ever have any contact with an agent or anyone associated with an agent?  [Bylaw 12.3.1]		YES     NO 

Did you sign any kind of agreement with the agent?		YES     NO

Did you accept any benefits from an agent or anyone associated with an agent?		YES     NO

j.	Please list all official visits taken.   
	_____________________________________________________________

Part III – International/Select Student-Athlete Information.

Part III of this form is to be completed by your institution's eligibility-certification officer based on the above responses.  

Please proceed to the last page and complete the International/SELECT Student-Athlete Affirmation and return this form to the appropriate athletics department officials.

Part III – International/Select Student-Athlete Information.

The purpose of the information below is to ascertain whether the individual previously has been involved with a team that is considered a professional team, or received prohibited forms of pay pursuant to NCAA rules.  An individual loses amateur status if he or she competes on any professional athletics team, or receives benefits not authorized by the NCAA.  Please note if the student-athlete did not know an answer to any of the above questions, it is the institution’s responsibility to further investigate the information.

The following questions will enable the NCAA institution to better determine the individual's eligibility status.

Part A:  High School Graduation Information.

1.	Student-athlete’s high school graduation date as determined by the NCAA Initial-Eligibility Clearinghouse: __________________

2.	Graduation date of the student-athlete’s high school class (as determined by the first year of high school enrollment, or the international equivalent, as specified in the NCAA Guide to International Academic Standards for Athletics Eligibility): ________________

Part B:  Professional Team Issues.

Has the individual competed on any organized team that:
Yes	No			
_______	______	1.	Declares itself as a professional team;	
_______	______	2.	Has any athlete on the team received for his or her participation any kind of payment, directly or indirectly, above actual and necessary expenses from a professional team or professional sports organization.	

Part C:  Additional Amateurism Issues.

Has the individual:
Yes	No			
_______	______	1.	Accepted any direct or indirect salary, gratuity or comparable compensation for the individual's participation on a team;	

_______	______	2.	Received prize money or payment based on the individual's performance in competition that exceeds actual and necessary expenses from the sponsor of the event;	
_______	______	3.	Received prize money or payment based on the individual's performance in competition, including actual and necessary expenses, from an individual or entity other than the sponsor of the event;	
_______	______	4.	Received prize money or payment based on the individual’s performance in competition, including actual and necessary expenses, in an event other than an open athletics event;	
_______	______	5.	Received preferential treatment, benefits or services because of the individual's athletics reputation or skill other than expressly authorized by NCAA rules;	
_______	______	6.	Received expenses to participate in a competition from the outside professional team that the individual is representing in the event.	
_______	______	7.	Entered into an oral or written agreement with an agent.	
_______	______	8.	Signed a contract or entered into an oral or written commitment of any kind for participation in professional athletics.	

The individual may have jeopardized his or her amateur status and may not be eligible for intercollegiate competition in a particular sport if the answer to any of the questions in Part C is "YES."  Therefore, it is incumbent on the institution to further investigate the individual's amateur status.

INTERNATIONAL/SELECT STUDENT-ATHLETE'S AFFIRMATION

By signing below, I, _______________________________________, affirm that I have 

(Student-Athlete's Name)	
discussed the information I provided on this form with the eligibility-certification official 	
at __________________________________ to determine my eligibility for participation
          (Name of Your NCAA Institution)	
in intercollegiate athletics.  I have completed and reviewed the responses to the questionnaire above and agree that the information is correct.  The eligibility-certification official has reviewed NCAA Bylaw 10.1 with me and I understand that if I knowingly have given false or misleading answers to these questions, I will jeopardize my eligibility for participation in intercollegiate athletics at NCAA institutions.	

Student-Athlete's Signature		Date	

 [Note:  You may wish to keep a copy of this form should you enroll at or transfer to another NCAA institution.]

ELIGIBILITY-CERTIFICATION OFFICIAL'S AFFIRMATION

By signing below, I, ____________________________________, affirm that I have

(Eligibility-Certification Official's Name)	
reviewed the responses to the questionnaire above as well as other information and agree 	
that _____________________________________ has met all academic-eligibility re
                          (Student-Athlete's Name)	
quirements (including certification by the NCAA Initial-Eligibility Clearinghouse, if a freshman) and other general-eligibility requirements and, therefore, is eligible for participation in intercollegiate athletics.	

Eligibility-Certification Official's Signature		Date	

Head Coach's Affirmation

By signing below, I, __________________________, affirm that I have read and understand the application of NCAA Bylaw 10.1, and the information provided by the student-athlete is accurate and complete to the best of my knowledge.	
			
Head Coach's Signature		Date