Form 02-3a                                              		       Academic Year 2002-03

			    Student-Athlete Statement  Division I            
					
For:	Student-athletes	
Action:	Sign and return to your director of athletics	
Due date:	Before you first compete each year	
Required by:		NCAA Constitution 3.2.4.5 and NCAA Bylaws 14.1.3.1 and 30.12	
Purpose:	To assist in certifying eligibility	
																
TO:  STUDENT-ATHLETE
Name of your institution:  ________________________________________________________
This form has four parts: a statement concerning eligibility, a Buckley Amendment Consent, an Affirmation of a Valid ACT or SAT score and Results of Drug Tests.  You must sign all four parts to participate in intercollegiate competition.
Before you sign this form, you should read the Summary of NCAA Regulations provided by your director of athletics 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 you may contact the NCAA at 317/917-6222.
The conditions that you must meet to be eligible and the requirement that you sign this form are indicated in the following articles and bylaws of the NCAA Division I Manual:
	Articles 10, 12, 13, 14, 15 and 16
	Bylaws 14.1.3.1, 18.4 and 31.2.3
Part I:  Statement Concerning Eligibility
By signing 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 you have read the Summary of NCAA Regulations or the relevant sections of the NCAA 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 organized gambling.
You affirm that you are aware of the NCAA drug-testing program and that you have signed the 2002-03 Drug-Testing Consent (Form 02-3d).
You affirm that you have reported to the director of athletics of your institution any violations of NCAA regulations involving you and your institution.
You affirm that you understand that if you sign this statement falsely or erroneously, you violate NCAA legislation on ethical conduct and you will further jeopardize your eligibility.

__________________________________	_____________      ___________
Name (Please Print)	Date of Birth	Age

_________________________________	____________________________
Signature of Student-Athlete	Home Address (Street or P.O. Box)

__________________________________	                                                        	             
Date	Home City, State, and Zip Code

______________________________________________________________________Sport(s)

Part II: 	Buckley Amendment Consent
By signing 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, the following documents:
		This form;
		Results of NCAA drug tests; 
		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 and dates and letters of test-score certification or appeal), and where applicable, information relating to eligibility for or conduct of nonstandard testing;
		Records concerning your financial aid; and
		Any other papers or information pertaining to your NCAA eligibility.

You agree to disclose these records only to determine your eligibility for intercollegiate athletics, your eligibility for athletically related financial aid, for purposes of inclusion in summary institutional information reported to the NCAA (and which may be publicly released by it), for NCAA longitudinal research studies and for activities related to NCAA compliance reviews. 

Further, you authorize the NCAA to disclose personally identifiable information from your educational records (including information regarding any NCAA violations in which you may become involved while you are a student-athlete) to a third party (including but not limited to the media) as necessary to correct inaccurate statements reported by the media or related to a student-athlete reinstatement case, infractions case or waiver request.  You also agree that necessary case information (i.e., information from your student-athlete reinstatement case, infractions case or waiver request) may be published or distributed to third parties as required by NCAA bylaws, policies or procedures.  You will not be identified by name by the NCAA in any such published or distributed information.
___________________________________	____________________________
Date	Signature of Student-Athlete
Part III:	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.

___________________________________	_______________________________
Name (Please Print)	Date

___________________________________	
Signature of Student-Athlete	
Part IV: Results of Drug Tests
You affirm that you have not tested positive for substances banned by the NCAA and/or by a non-NCAA national or international athletics organization.  Further, you understand that if you tested positive, you are subject to an NCAA drug test, and you must notify any institution to which you transfer regarding the positive result.
___________________________________	_______________________________
Name (Please Print)	Date
_____________________________________	
Signature of Student-Athlete	

What to do with this form:  Sign and return it to your director of athletics before you first compete.  This form is to be kept in the director of athletics' office for six years.