Fillable General Amateurism and Eligibility Form for International Student-Athletes (Luther College)

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General Amateurism and Eligibility Form for International Student-Athletes (Luther College)

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Form 20-10c Academic Year 2020-21
General Amateurism and Eligibility Form for International
Student-Athletes – NCAA Division III
For: NCAA Division III institutions.
Action: Complete for each international student-athlete and file at your institution with
other eligibility documents.
Due date: Prior to practice or competition.
Required by: NCAA Division III Bylaw 14.1.5.1.
Purpose: To certify international student-athletes for intercollegiate practice or competition
and assess compliance with NCAA general amateurism and eligibility rules.
Part I. Institutional Guidelines.
To be eligible to represent an institution in intercollegiate athletics practice or competition, an
international student-athlete shall be certified as eligible using this form. An international student-
athlete is a student-athlete who either:
1. Is not a U.S. citizen; or
2. Resides in an unincorporated or commonwealth territory of the United States; or
3. Has participated in international athletics activities or was associated as an athlete with an
international athletics organization.
Each international student-athlete who is participating for the first time in intercollegiate athletics
at the certifying institution should be given this form to complete and sign. The form should be
completed in the presence of the institution's eligibility certification official. It may be necessary
for an institutional administrator to assist the student-athlete in understanding terms and to ensure
that the student-athlete responds to all items. Subsequent to the student-athlete completing the
form, the institution's eligibility official is responsible for investigating any answers that may result
in ineligibility. Further, the statement must be signed by the institution's eligibility official and the
student-athlete's head coach prior to the student-athlete engaging in competition. The completed
form shall be maintained on file at the institution with other eligibility documents for a period of
six years. [NCAA Bylaw 14.1.5.1]
Please be aware that your institution is responsible for:
1. Reviewing NCAA Bylaw 10.1 with the student-athlete to ensure that all information is
provided truthfully and that the student-athlete is aware that further eligibility
consequences could result if false and misleading information is provided.
2. Verifying the validity of the information provided by the student-athlete.
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 20-10c
Page No. 2
_________
3. Analyzing the information submitted by the student-athlete and applying general
amateurism and eligibility rules, particularly those related to amateurism, to determine the
student-athlete's general eligibility. (NCAA Manual citations are included after each item
to assist in this effort.)
4. Contacting the NCAA academic and membership affairs staff for assistance in determining
the correct application of NCAA rules.
5. Advising the student-athlete that the information being provided through this form can
affect the individual's eligibility.
[Note: International student-athletes also must sign the NCAA Student-Athlete Statement,
NCAA Affirmation of Eligibility and NCAA Drug-Testing Consent form.]
Part II. International Student-Athlete Information.
[Please note that this section is to be completed by the student-athlete.]
To be eligible for intercollegiate athletics practice and competition, every student-athlete must
meet all applicable NCAA eligibility requirements. As an international student-athlete, you are
being asked to complete this form because it will make it easier for your institution to determine
your eligibility under NCAA rules.
This questionnaire does not relate to your admission to the school—the admissions office of your
institution will handle that process separately.
You must respond to each item below and sign the form to compete in intercollegiate athletics at
an NCAA institution. (Use "N/A" if the question does not apply to you.) Ask an administrator at
your school for help if you do not understand an item. (References to NCAA Bylaws that follow
each item are for your institution's use.) The school's eligibility-certification official and your head
coach also must sign the completed form and keep it on file at the school with other eligibility
documents.
Please note that the information you provide on this form will be used to certify your
eligibility and thus may impact your eligibility to compete at an NCAA institution. In
addition, under NCAA rules you are required to provide accurate information. The knowing
provision of false and misleading information on this form may result in additional
consequences to your NCAA eligibility.
[Note: In completing the following items, please use the back of the pages if you need
additional space.]
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 20-10c
Page No. 3
_________
1. General Information.
Full name: ____________________________ Sport(s): _________________________
Home country:_________________________
Date of birth: _______/______/______ Date of high school graduation:________
Month Day Year
Government Identification Number: _____________________________
[Note: This is similar to a social security number.]
International student-athletes must provide appropriate visa and/or other government
documentation in accordance with local, state and federal laws and member schools will be
required to maintain copies of such documentation on file in the athletics department.
2. Educational Background.
Please list all schools attended (e.g., high schools, preparatory schools, etc.).
Year
Name of
School
Country
Tuition
Amount (if
applicable)
Degree
Received
Date
a. Did you at any time discontinue full-time high school enrollment?
YES NO
If "YES", when? ___________________________________________________
b. For all schools where tuition was required, please indicate who paid for your
expenses (e.g., parents, coach, school, athletics team, government, family friend,
other individual, etc.) [Bylaw 12.1.7.3]
School
Tuition Paid By
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 19-10c
Page No. 4
_________
c. Did you ever attend classes in a regular term as a full-time student (not a vacation
or holiday term) at a collegiate institution in the United States or elsewhere?
YES NO
If yes, please provide the name of the school(s) and the years attended.
(Bylaw 14.2.2)
School
Years Attended
d. Participation on an organized team.
Please list all organized teams you have participated on and include the dates which
you participated.
Team
Dates
Please respond to the following questions regarding your participation on the teams
mentioned.
(1) Did you or members of your team receive actual and necessary expenses for
your participation on any of the teams mentioned above? (Bylaws 12.02.4,
12.02.5, 12.1.1, 12.1.3 and 12.1.5) YES NO
If yes, please indicate which team provided the expenses and what expenses
were paid.
Team
Expenses
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 19-10c
Page No. 5
_________
(2) Did you receive any money above actual and necessary expenses for your
participation on any of the teams mentioned in section two?
(Bylaws 12.02.5, 12.1.1, 12.1.3 and 12.1.5) YES NO
(3) Did any members of your team receive money above actual and necessary
expenses for his or her participation on your team (e.g., salary)?
(Bylaw 12.02.5, 12.2.3.2) YES NO
(4) Did you sign any type of contract or agreement to participate on any of the
teams mentioned in section d? (Bylaws 12.02.5, 12.1.1, 12.1.3.1 and
12.1.5.2) YES NO
If yes, for which team? (Please provide a copy of the agreement signed.)
___________________________________________________________
(5) Did any of the teams you participated on recognize themselves as a
professional team? (Bylaw 12.02.5) YES NO
If yes, which ones?
___________________________________________________________
e. Participation as an individual.
Please list all events in which you participated as an individual, the dates you
participated and the amount of prize money you received for your participation.
Event
Dates
Prize Money Received
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 20-10c
Page No. 6
_________
f. Additional issues.
(1) Have you accepted any other benefits not listed on this form from
individuals other than your parents or legal guardians? (Bylaw 12.1.1)
YES NO
(2) Have you ever been involved in an advertisement or promotional activity?
(Bylaw 12.5) YES NO
(3) Have you ever accepted any remuneration of any kind for your participation
in an advertisement or promotional activity? (Bylaw 12.5)
YES NO
(4) Who paid for your transportation to the United States?
___________________________________________________________
(5) When did you first arrive in the United States?
___________________________________________________________
(6) Where did you live once you arrived in the United States and with whom
did you live? ________________________________________________
(7) Did you ever have any contact with an agent or a runner? (Bylaw 12.3.1)
YES NO
If yes, did you sign any kind of agreement with the agent?
YES NO
Did you accept any benefits from an agent or a runner?
YES NO
______________________________________________________________________________
Part III. International Student-Athlete Information.
Part III of this form is to be completed by your school's eligibility-certification officer based
on the above responses.
STUDENT-ATHLETE: PLEASE PROCEED TO THE LAST PAGE AND COMPLETE
THE INTERNATIONAL STUDENT-ATHLETE AFFIRMATION AND RETURN THIS
FORM TO THE APPROPRIATE ATHLETICS DEPARTMENT OFFICIALS.
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 20-10c
Page No. 7
_________
The purpose of the first section below is to ascertain whether prior to initial collegiate enrollment,
the individual has been involved with a team or in individual competition that would result in the
use of a season of participation pursuant to Bylaw 14.2.4.4.
The following questions will enable the NCAA member institution to better determine the
individual's eligibility status.
Did the student-athlete enroll in a collegiate institution as a full-time student in or before the
regular academic term that begins immediately after a one-year period (the next opportunity to
enroll after the one calender year period has elapsed) following his or her high school graduation?
YES NO
If no, complete Sections No. 1 and No. 2 below.
If yes, skip to Section No. 2 below.
1. Participation in Organized Competition.
Did the individual:
Yes
No
_____
_____
a.
Participate in any team competition or training in which pay in any
form was
provided to any of the participants above actual and
necessary expenses;
_____
_____
b.
Participate in any individual competition or training in which the
individual accepted pay in any form based on his or her place finish;
_____
_____
c.
Participate in any competition or training in which the individual
accepted pay in any form above actual and necessary expenses;
_____
_____
d.
Participate in any competition pursuant to the signing of a contract
for athletics participation or entering a professional draft; or
_____
_____
e.
Participate in any competition funded by a representative of
athletics interests that was not open to all participants.
2. Additional Amateurism Issues.
Has the individual:
Yes
No
_____
_____
a.
Accepted any direct or indirect salary, gratuity or comparable
compensation for the individual's participation on a team;
_____
_____
b.
Received prize money or payment based on the individual's
performance in competition;
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 19-10c
Page No. 8
_________
_____
_____
c.
Received preferential treatment, benefits or services because of the
individual'
s athletics reputation or skill other than expressly
authorized by NCAA rules;
_____
_____
d.
Received educational expenses that were based in any degree on
the recipient's athletics ability (even if the funds are given to the
institution to administer to the recipient);
_____
_____
e.
Entered into an oral or written agreement with an agent;
_____
_____
f.
Signed a contract or entered into an oral or written commitment of
any kind for participation in athletics after initial full-time
collegiate enrollment.
If the answer to any of the questions in Sections No. 1 or No. 2 is "YES," the individual may not
be immediately eligible for intercollegiate competition in a particular sport. Therefore, it is
incumbent on the institution to further investigate the individual's amateur status.
Please note that an individual who does not enroll in a collegiate institution as a full-time
student in the regular academic year term that begins immediately after a one-year period
(the next opportunity to enroll after the one calendar year period has elapsed) following their
high school graduation date (or the international equivalent as specified in the NCAA Guide
to International Academic Standards for Athletics Eligibility) shall use a season of
intercollegiate participation for each consecutive 12-month period after the one-year time
period and before the initial-collegiate enrollment in which the individual participates in
activities that meet the criteria set forth in Bylaw 14.2.4.4.2. (Please see Bylaw 14.2.4.4.2.1
for exceptions to this rule.) Further, an individual who uses a season of participation per
Bylaw 14.2.4.4 shall fulfill one academic year in residence prior to being eligible to represent
the institution in intercollegiate competition.
International Student-Athlete's Affirmation
By signing below, I ___________________________________________, affirm that I have
(Student-athlete's name)
discussed the information I provided on this form with the eligibility-certification official at
_____________________________________ to determine my eligibility for participation in
(Name of your NCAA institution)
intercollegiate athletics. I have completed and reviewed the responses to the questionnaire above
and agree that the information is correct. I understand that if I knowingly have given false or
misleading answers to these questions, I will jeopardize my eligibility for participation in
intercollegiate athletics at NCAA member institutions.
_______________________________________________ ______________________
Student-athlete's signature Date
[Note: You may wish to keep a copy of this form should you enroll at or transfer to another
NCAA institution.]
General Amateurism and Eligibility for International
Student-Athletes – Division III
Form 20-10c
Page No. 9
_________
NCAA/05_11_2020/KP:gmd
Eligibility Certification Official's Affirmation
By signing below, I ___________________________________________, affirm that I have
(Eligibility-certification official's name)
reviewed the responses to the questionnaire above as well as other information and agree
that_____________________________________ has met all academic-eligibility requirements
(Student-athlete's name)
and other general eligibility requirements and, therefore, is eligible for participation in
intercollegiate athletics.
_______________________________________________ ______________________
Eligibility-certification official's signature Date
______________________________________________________________________________
Head Coach's Affirmation
By signing below, I __________________________, affirm that the information provided by the
student-athlete is accurate to the best of my knowledge. I understand that I am responsible under
NCAA Bylaw 10.1 to provide truthful information.
______________________________________________ _______________________
Head coach's signature Date
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General Amateurism and Eligibility Form for International Student-Athletes (Luther College)

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Completed 22 August 2020

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