CAL STATE FULLERTON ATHLETICS

TRANSFER RESIDENCE REQUIREMENT WAIVER

A.	General Information
	1.	Student's Name   	     
	2.	Student's Sport    	     
	3.	Transferring From	     
	4. 	Phone #       	Fax #       
B.	Initial-eligibility
	1.	Was this student recruited by your institution?  Yes  No
	2.	Was this student certified by the Clearinghouse?  Yes   No
		If no, was he/she a  partial, or a  non-qualifier
	3.	Did he/she sign a National Letter of Intent? Yes  No
C.	Historical Data
	1.	Was this student enrolled at your institution?	
		Yes	 No
		Date of entrance			Date of withdrawal 	
		Check student's classification upon entrance:	FR   SO   JR   SR
	2.	Did this student participate in your athletic program?
		Yes	 No
		What sport(s)		Academic year(s)	# Years of Eligibility Used

									
		
3.	Is this student-athlete in good academic standing at your institution and would he/she have been academically eligible for competition were he/she to remain at your institution for the
20    -20     year?
		Yes	 No

		If no, explain		
				
	4.	Is this the first 4-year to 4-year transfer for this student-athlete?
		Yes	 No
		If no, previous 4-year institution		

D.	Waiver Statement (If applicable)
	If the student qualifies, there is no objection to the student being granted an exception to the transfer residence requirements.  In granting this waiver, I certify that all information contained in Section C of this form is accurate.

	________________________________	______________________________
	Name	Title
	________________________________	______________________________
	Signature	Date

Return this form to:	Dr. June F. Kearney, Assistant Director of Athletics, Compliance
			California State University, Fullerton
			P.O. Box 6810
			Fullerton, CA  92834-6810
			714-278-3431      714-278-5396  FAX