Student-Athlete: _______________________ SS# _____________________ Sport: _______________
_____ Has enrolled at IUPUI _____ Has requested permission to speak with IUPUI
An official release is granted to this student-athlete: ___ Yes ___ No
Entry date at your institution: ______________________ Semester/Yr.
Last semester attended: ___________________________ Semester/Yr.
Has this student transferred from any other institution(s)? ___ Yes ___ No
School: _____________________ Four-Year ___ Division ___ Two Year ___ NAIA ___ Foreign ___
Enrollment: ___________ Sem/ ______ Yr. to ______ Sem/______ Yr. ______
Did student-athlete compete at previous institution(s)? ___ Yes ___ No
Participation Record at previous institution(s):
|
Sport |
Term/Year |
Participation (Circle) |
|
F/S 19________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
Athletics History at Your Institution:
|
Was the student-athlete recruited? |
Y |
N |
|
Did this student-athlete sign a National Letter of Intent? |
Y |
N |
|
Did this student-athlete receive countable athletic aid? |
Y |
N |
|
Was this student-athlete a NCAA qualifier? |
Y |
N |
|
Will you send us a copy of the student-athlete’s 48C |
Y |
N |
|
If currently enrolled, is this student-athlete considered to be "in good academic standing"? If not currently enrolled, was this student-athlete in "good academic standing" at the time of withdrawal? |
Y Y |
N N |
|
Has this student-athlete fulfilled the satisfactory progress requirement? |
Y |
N |
|
Would this student-athlete have been eligible had he/she remained at your institution? |
Y |
N |
|
Has this student-athlete’s sport been dropped? If yes, date _____________________ |
Y |
N |
|
If AN OFFICIAL RELEASE IS GRANTED is a one-time exception to the transfer residence requirement granted? If no, why? _________________________________________________ |
Y |
N |
|
Comments: |
Participation Record at Your Institution:
|
Sport |
Term/Year |
Participation (Circle) |
|
F/S 19________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
|
|
F/S __________ |
Competed Practiced Only Did not participate |
Signature: _________________________________ Phone: ________________
Institution: ________________________________
Title: _____________________________________ Date: _________________
cc: Head Coach
Compliance Office