Fillable NJCAA Eligibility Affidavit (Northern Essex Community College)

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NJCAA Eligibility Affidavit (Northern Essex Community College)

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The NJCAA Eligibility Affidavit (Northern Essex Community College) form is 2 pages long and contains:

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U.S.A. forms for Northern Essex Community College

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NJCAA Eligibility Affidavit
SPORT: ______________________ Date: _____________
Fill in all applicable information on this form to assist in determining eligibility for the NJCAA.
Personal Information:
Name: ________________________________ Birth Date: __/__/____ ID Number : ________________
(First, Middle, Last)
Student’s College Address: ____________________________ ________________________________
Street Address City, State, Zip Code
Phone Number(s) at College: ________________________________ Email Address: _______________________
Other Information:
Parent’s Home Address: ___________________________ __________________________________
Street Address City, State, Zip Code
Phone Number: ________________________________ Parents’ Names: ________________________________
Foreign Born Students:
Do you have an I-20 Form on file at this college? Yes _____ No _____
High School Information:
Name of High School(s) you have attended: _________________________________________________
City, State & Country: ________________________________________________________________
Did you graduate?: Yes* _____ No _____ High School Graduation Date (month/date/year): __/___/____
Were you home schooled? Yes _____ No _____ Did you graduate? Yes* _____ No _____
Check here if you have earned a *GED or state department of education approved high school equivalency test
Yes_____ No_____ If yes, enter the date earned (month/date/year):
__/___/____
* Enclose a COPY of your High School Transcript, and GED Certificate or state department of education approved
high school equivalency test (if applicable).
Additional Information:
1. Did you take any college credit classes while in high school? Yes* _____ No _____
* If yes, from what college(s)?
_________________________________________________________
* If yes, those transcript(s) from each college must be on file at this college.
2. Have you ever signed a Letter of Intent form with any institution? Yes _____ No _____
If yes, specify the College: __________________________________ Date (day/month/year): ____/____/______
3. Have you ever participated in a sport in a country other than the United States? Yes _____ No _____
Sport(s)? _______________________ Country: ________________________ Dates: ___________________
If yes, describe the situation: ______________________________________________________________________
______________________________________________________________________________
4. Have you ever been red-shirted for a season? Yes _____ No _____
If yes, list the dates of that season, name of college, and describe the situation.
________________________
______________________________________________________________________________
______________________________________________________________________________
(Page 2 - NJCAA Eligibility Affidavit Continued)
5. Have you ever participated in practices, scrimmages, and/or games for an intercollegiate team other than this
college? Yes _____ No _____ If yes, name the school, date, sport, and describe the situation.
_____________
______________________________________________________________________________
______________________________________________________________________________
6. Have you ever played on a club team at a college or university? Yes _____ No _____ If yes, name the school,
sport and dates.
_______________________________________________________________
______________________________________________________________________________
7. Do you currently play on any other sport teams (i.e. USAV, city recreational leagues, indoor soccer, AAU, etc.)
Yes _____ No _____. If yes, please provide the name of team, location, and dates of participation.
_
_____________________________________________________________________________
8. Have you ever received money beyond expenses for participating in any athletic event? Yes _____ No _____
Did anyone on your team receive money beyond expenses for participating in any athletic event? Yes ____ No ____
If yes, describe the situation below and 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 included.
College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)
College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)
College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)
College: ________________________ Dates: _____________________ Full-time or Part-time? (circle one)
Additional Explanations:
NOTE: 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 use the space below. Please record months and years when referring to dates.
_______________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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 Signature: ______________________________________________ Date: ______________________
Coach Signature: _____________________________________________________ Date: ______________________
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NJCAA Eligibility Affidavit (Northern Essex Community College)

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Completed 26 July 2020

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