NJCAA Eligibility Affidavit

NJCAA Eligibility Affidavit

(please read carefully & understand before you sign)
Personal Information
Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Student Number
ex. A00123456
Cell Number

Country CodeArea CodePhone Number
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent Name
Parent Phone Number

Country CodeArea CodePhone Number
Do you have an I-20 Form on file at Vincennes University (foreign-born athletes only)?
High School Information
Name of high school(s) you have attended:
Location of high school

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Did you graduate?
High School Graduation Date

MonthDayYear
Date
Were you home schooled?
Did you graduate from home school?
Have you earned a GED or state department of education approved high school equivalency test?
Date GED/Equivalency Earned

MonthDayYear
Date
Additional Information
Did you take an college credit classes while in high school?
If yes, list the college(s).
transcripts from each college must be on file at Vincennes University
Have you ever signed a Letter of Intent form with any institution?
If yes, list the college(s) and date(s).
Have you ever participated in a sport in a country other than the United States?
If yes, list the sport(s), country/countries of participation, date(s) of participation, and describe the situation.
Have you ever been red-shirted for a season?
If yes, list the dates of that season, name of the college, and describe the situation.
Have you ever participated in practices, scrimmages, and/or games for an intercollegiate team other than Vincennes University?
If yes, name the school, date, sport, and describe the situation.
Have you ever played on a club team at a college or university?
If yes, name the school(s), sport(s), and date(s).
Do you currently play on any other sports teams (i.e. USAV, city recreational leagues, indoor soccer, AAU, etc.)?
If yes, please provide the name of the team, location, and date(s) of participation.
Have you ever received money beyond expenses for participating in any athletic event?
Did anyone on your team receive money beyond expenses for participating in any athletic event?
If yes, describe the situation. Additionally, the NJCAA Amateurism Questionnaire should be completed and included with the eligibility file.
List All Colleges Attended Full-Time and/or Part-Time after High School

all transcripts from all previous institutions must be on file at Vincennes University
Additional Explanations
If you attended college part-time or were not attending college for any period of time following high school graduation, please document your employment and military history during those times in the space below. If you were unemployed at any time, please list those dates below. The NJCAA requires that you account for any time not enrolled full-time. Please record months and years when referring to dates.
Attestation
I certify, under penalty of perjury of the laws of the State of Indiana, that I have read the contents and warning of this acknowledgement; that I fully understand this acknowledgment; that I am in agreement with the terms of this acknowledgment; that I am signing this acknowledgement voluntarily, under no compulsion; that I have had an opportunity to ask questions and seek advice regarding this acknowledgement; that I am age 18 or over or, if not, that my parents/guardians hereby make these promises on my behalf; and that I choose to participate (or to permit my child or ward to participate) in the Vincennes University activity listed below of my own accord.

I understand that information falsified or omitted can make me ineligible for ALL future college competition in compliance with the National Junior College Athletic Association Eligibility Rules.
Student-Athlete Legal Name

First NameLast Name
Student-Athlete Student Number
ex. A00123456
Student-Athlete Date of Birth

MonthDayYear
Date
Student-Athlete Cell Number

Country CodeArea CodePhone Number
Student-Athlete Email
example@example.com
Head Coach Email
Primary Sport
Student-Athlete Signature
Date

MonthDayYear
Date
Parent/Legal Guardian Signature

(required if student-athlete is under 18)
Date

MonthDayYear
Date
Should be Empty:

NJCAA Eligibility Affidavit

Personal Information

High School Information

Additional Information

List All Colleges Attended Full-Time and/or Part-Time after High School

Additional Explanations

Attestation