Sport __________________________________
Student-Athlete __________________________________
Campus Address __________________________________
Permanent Address __________________________________
Years of Eligibility Remaining __________
Name of Outside Competition Team/Event ____________________________________
Date(s) of Competition ____________________________________
City/State of Outside Competition Team ____________________________________
Name of Outside Competition League ____________________________________
Names of current IUPUI student-athletes on Outside Competition Team:
___________________________________
___________________________________
___________________________________
| ____________________________ Signature | ____________________________ Date |
Please forward this document to the Compliance Office.