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SOUTH DAKOTA HIGH SCHOOL ACTIVITIES ASSOCIATION ANNUAL ATHLETIC

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SOUTH DAKOTA HIGH SCHOOL ACTIVITIES ASSOCIATION
P.O. Box 1217, Pierre, SD 57501
ANNUAL ATHLETIC ELIGIBILITY REPORT
SCHOOL YEAR:
THIS REPORT MUST BE SENT TO THE EXECUTIVE DIRECTOR BY MAY 1
st
.
* A $50.00 late fee will be assessed for failure to meet the deadline.
Date of making this report
. I hereby certify the following pupils, and no others, have represented
High School of (town) in Interscholastic
Athletics during the first and/or second semesters of the school year and the data opposite their names is correct.
Total number of students listed on this annual report ..........................................................................................................................................
Total number of cheerleaders who represented your school during the school year who did not participate in athletics .......................................
Signed Date
Superintendent or Principal or Athletic/Activities Director
INCLUDES BOTH BOYS AND GIRLS
Do not list 7th and 8th graders unless they actually participate on a high school team.
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
A detailed computerized list may be attached if it contains all of the pertinent information
NOTE: Please fill out all columns and in detail in regard to each student. This report is also used to determine your catastrophic
insurance premium for the ensuing school year.
MAKE REPORT IN DUPLICATE, RETAIN ONE COPY FOR YOUR FILES, MUST BE TYPE-WRITTEN.
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date))
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date)
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
FULL NAME
List names alphabetically
BIRTH
DATE
MM/DD/YY
Date of
Examination
(Not History
Date))
Other Schools
Where Student
has Competed
Academic
Classification of
Students during
School Year
7th, 8th, 9th,
10th, 11th, 12th
No. of Semesters in
Attendance Grades 9-12
including withdrawal
semesters
(must be consecutive)
Select One
Annual
Bienniel
Triennial
No. of First
Semesters
No. of
Second
Semesters
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SOUTH DAKOTA HIGH SCHOOL ACTIVITIES ASSOCIATION ANNUAL ATHLETIC

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Completed 29 July 2021

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