WAIVER OF NCAA SATISFACTORY-PROGRESS REQUIREMENTS

AND

FULL-TIME ENROLLMENT REGULATIONS FOR STUDENT-ATHLETE WITH DISABILITIES

2002-03 WAIVER APPLICATION

This application must be completed and submitted with the requested information before the NCAA Division I Committee on Satisfactory-Progress Waivers, NCAA Division II Academic Requirements Committee Subcommittee on Satisfactory-Progress Waivers or Division III Management Council Subcommittee on Academic Issues may process the waiver request.  In addition, the committee or subcommittee may request pertinent information before the final determination of this case.  Please note that special waiver criteria exist for students with disabilities.

The committee or subcommittee must receive a complete collegiate educational and athletics history from ALL institutions attended, with corresponding transcripts and any other relevant documentation, before it may review the waiver request.

(PLEASE TYPE OR PRINT)

1.	Institution:      		Division:	     	

2.	Student-athlete’s name:	     		SSN:	     	

3.	Sport:	     	

4.	Was the student-athlete recruited (see Bylaw 13.02.11.1)?	YES:		NO:	

5.	Seasons of competition remaining:	     	

6.	Student-athlete’s next scheduled contest or date of competition:	     	

7.	Waiver request per Bylaw (list all the apply):	     	

8.	Please list the amount of the deficit for which the waiver is requested (i.e., credit hour or grade-point average deficiency):     	
 
9.	Please list reasons for the deficiency (attach additional documentation, if any, to verify this information and label “ATTACHMENT A.”):     	

10.	
Is the deficiency the result of the institution’s advice?  If YES, written documentation from the individual(s) who misadvised the student-athlete must be provided detailing the incident(s).

11.	Has this individual previously requested a waiver of satisfactory progress? 	YES		NO	

If YES, please list date of request, whether request was granted or denied and type of waiver (i.e., Bylaw reference).
     	

12.	Student-athlete’s status:
	
a.	When did the student-athlete enroll in a collegiate institution as a full-time student?
	     	

b.	When did the student-athlete first enroll at your institution as a full-time student?
	     	

c.	At the time of the application, had the student-athlete fulfilled the requirements of Bylaw 14.4.3.1 (12/24-hour rule)?	YES:		NO:	

d.	Did the student-athlete enroll in summer school?	YES:		NO:	
	
	If NO, please explain:	     	

			

			

	If YES, please list the courses in which the student currently is enrolled.  Attach documentation to verify this information, and label as “ATTACHEMENT B.”

	On what date will the summer term be completed?	     	

e.	Is the student-athlete a transfer student?	YES:		NO:	

	If YES, how many credit hours were transferable to your institution?
	     	

	Of those hours, how many apply to the currently designated degree program at your institution?
	     	
f.	
Please list in chronological order the student-athlete’s collegiate educational and participation history.  (Attach transcripts to verify this information and label “ATTACHMENT C.”)  (Please list information on a term-by-term basis.  If more space is needed, please attach information using the same chart format.)

Academic Term/Year (example: Fall 2002)	Institu-tion	Part Time	Full Time	2-year institution	4-year institution	Athletics Aid Received? Y or N	Hours Attempted	Hours Completed	Did the student athlete compete? Y or N	Term GPA	Degree-Credit Hours	
F      	     	     	     	     	     	     	     	     	     	     	     	
W      	     	     	     	     	     	     	     	     	     	     	     	
S      	     	     	     	     	     	     	     	     	     	     	     	
SS1      	     	     	     	     	     	     	     	     	     	     	     	
SS2      	     	     	     	     	     	     	     	     	     	     	     	
F      	     	     	     	     	     	     	     	     	     	     	     	
W      	     	     	     	     	     	     	     	     	     	     	     	
S      	     	     	     	     	     	     	     	     	     	     	     	
SS1      	     	     	     	     	     	     	     	     	     	     	     	
SS2      	     	     	     	     	     	     	     	     	     	     	     	
F      	     	     	     	     	     	     	     	     	     	     	     	
W      	     	     	     	     	     	     	     	     	     	     	     	
S      	     	     	     	     	     	     	     	     	     	     	     	
SS1      	     	     	     	     	     	     	     	     	     	     	     	
SS2      	     	     	     	     	     	     	     	     	     	     	     	
F      	     	     	     	     	     	     	     	     	     	     	     	
W      	     	     	     	     	     	     	     	     	     	     	     	
S      	     	     	     	     	     	     	     	     	     	     	     	
SS1      	     	     	     	     	     	     	     	     	     	     	     	
SS2      	     	     	     	     	     	     	     	     	     	     	     	

Totals

g.	Student’s cumulative grade-point average:	     	

	Student-athlete’s GPA at certifying institution:	     	

	GPA’s earned at previous institution(s):	     	

h.	Please list the courses in which the student currently is enrolled. (Attach documentation to verify this information and label “ATTACHMENT D.”)

On what date will the current term be complete:      	

i.	Please list the student-athlete’s designated degree program [if one has been declared (see Bylaw 14.4.3.1.4)]:	     	

j.	Please list any other degree programs previously declared and indicate the official date of this change:

		Degree Program	Effective Date

		     		     	
		     		     	
		     		     	
		     		     	
		     		     	

k.	How many hours in the student’ degree program are required for graduation?
	     		semester hours or      		quarter hours or	     		other.

	Program length per official institutional catalog (please check one):

	 4 years

	 5 years

	 Other (please explain):      	

	(Please provide verification of required hours and label (ATTACHMENT E.”)

THE SIGNATURES OF THE FOLLOWING INDIVIDUALS ARE REQUIRED 
FOR ALL WAIVER REQUESTS:

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

			OR		
	Director of Athletics			Senior Woman Administrator

			AND

			OR		
	Faculty Athletics Representative			Chief Executive Officer

13.	Student-athlete’s signature:			

14.	Date Submitted: 	     	

15.	Primary Contact Person:	     	

16.	Position:	     	

17.	E-mail address:     	

18.	Facsimile Number:      	

19.	Telephone Number:      	

You may mail or fax (but Not both) this completed application, along with all applicable documentation, to:
		NCAA
		Membership Services
		P.O. Box 6222
		Indianapolis, Indiana 46206-6222

		Fax: 317/917-6622

For Federal Express or other overnight-delivery services, please use the address below:

		NCAA Distribution Center
		Membership Services
		1802 Alonzo Watford Sr. Drive
		Indianapolis, Indiana  46202

		Phone:  317/917-6222