Permission to Contact: Self-Release – Division III
Page No. 2
box on Page No. 2 of this form. At the end of the 30-day period, if you decide to transfer, your
new institution must notify your current institution within a seven-day period of the form's
expiration date that this form was issued.
3. If you decide not to pursue the transfer, the new college or university is not allowed to notify
your current institution of the contact at any time. If you are undecided at the end of the
30-day period, you must send a new copy of this form to have additional contact with the college
or university. Further, because this second release is beyond the first 30-day period, the new college
or university must notify, within seven days, your current institution that a second release was
4. By signing this form, you agree that you permit the named college or university to contact you for
a 30-day period from the date this document is signed. You also agree that if you decide to transfer,
or if you send a second self-release, the new college or university will notify your current institution
of these facts. Institutions in receipt of this form are not allowed to notify your current institution
of this release, unless:
a. You have granted permission for that notification to occur by checking the box near the
end of this form;
b. You notify the institution in receipt of the form that you have decided to transfer to that
c. You have issued a second self-release.
Signature of Student-Athlete Date
Name (please print) Name of current institution
Sport(s) of interest
Contact information (telephone number, email address, or physical address)
Check this box if this is the first release issued to this institution.
Check this box if you give the named college or university permission to notify your current
institution of this permission to contact during the 30 days this form is effective.
What to do with this form: Sign and send this form to the director of athletics at the college or university
you would like to contact about a possible transfer. You may send this form via facsimile, email or standard
mail, but the form must include a signature. If this form is emailed, it still must include a scanned signature.
This form is to be kept in the director of athletics' office for six years.