Indicate request. Check all that apply:
Extension of five-year period of eligibility r
Season-of-competition waiver, competition while
eligible r
Season-of-competition waiver, competition while
ineligible r
Hardship waiver – independent institution r
Hardship waiver – appeal r (Please note NCAA Division I must be submitted by conference office)
Athletics-activity waiver r
REQUEST FOR A WAIVER PROCESSED BY
STUDENT-ATHLETE REINSTATEMENT STAFF AND COMMITTEE
For Use by Member Institutions and
Conferences Only
This application must be completed and all required documentation must
be submitted before the NCAA student-athlete reinstatement staff may act on the
request.
Please note that all decisions issued by the student-athlete
reinstatement staff may be appealed to the NCAA Divisions I, II or III
Student-Athlete Reinstatement Committee.
Please type or print.
1. Applicant
institution:
__________________________ Conference: __________________________
2. Sport: ______________________________________ Division
(of sport): ____________________
3. Student-athlete's
name:
_________________________________________________________________
4. Student-athlete's
social security number:
________________________________
5. Student-athlete’s
date of birth ________________________________
6. Student-athlete’s
date of high school graduation __________________________
7. Seasons of
competition remaining:
___________________________________________
6. Student-athlete's
next scheduled contest or date of competition: _________________________________
7. Student-athlete's
status:
Date
of initial-collegiate enrollment:
____________________________
Date of initial-collegiate
enrollment at applicant institution, if different: ______________________
8. Was
the student-athlete recruited?
______________
9. Is the
student-athlete on athletically related financial aid?
______________________________
For all waivers, this first
page must be completed. In
addition, please complete the section of this application that is specific to
the waiver you are requesting.
Please note that all waiver cases include the submission of supporting
documentation that must be included for the case to be processed. Please include the required supplemental
documentation with this application when submitting the information to the
student-athlete reinstatement staff.
If you have any questions when completing this form, please contact the
student-athlete reinstatement staff at 317/917-6015. Waiver request may be submitted to
Jennifer Strawley, director of membership
services/student-athlete reinstatement by fax to
(317) 917-6881.
d. Please
list the years/seasons the institution considers to be denied participation opportunities.
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List at least two seasons in which the
institution believes student-athlete was deprived of a participation
opportunity pursuant to NCAA Bylaw 30.6.1.1.
|
State specific bylaw within 30.6.1. that
applies to student-athlete's circumstances that prevented student-athlete
from participating
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For physical or mental circumstances, is
medical documentation contemporaneous (at the time of the injury or
illness)? If so, where was the
documentation obtained?
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Does institution
believe student-athlete's circumstances meet Bylaw 30.6.1.1 criteria? If so, why? If not, does the institution believe
student-athlete's circumstances should be considered an extraordinary or
extreme hardship case? If so why?
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e. In
addition, to the application the following information should be submitted with
an extension request:
r
Student-athlete's complete academic transcript
(including all institutions attended).
r
Written statement from student-athlete describing
circumstances surrounding extension request.
r
If request is for medical reasons, medical
documentation that when analyzed together, demonstrates that the injury or
illness was "incapacitating" in nature and prevented the
student-athlete from competing during a specific season. Legislation requires that documentation
must be contemporaneous and include a letter from the treating physician
describing the nature of the injury or illness and whether it was
incapacitating. (Please note
that contemporaneous medical documentation includes, but is not limited to,
doctor's notes, doctor's evaluations, emergency room records, physical therapy
records, nurse's records and/or records.
The documentation must be from the time of the injury and generally
include a description and diagnosis of the patient's condition.)
r
For situations where competition occurred and the
conference office has granted a hardship waiver, please include documentation
of the hardship waiver.
r
For financial hardship, documentation should be
included to substantiate the specific event and demonstrate how the specific
event prevented competition.
r
For matters involving erroneous reliance, personal
or family finances, natural disasters or other nonmedical
circumstances that the institution believes meet the criteria detailed in Bylaw
30.6.1.1, objective documentation should be presented from the appropriate
authority.
r
Any other documentation that is relevant to the
discussion of the waiver.
2. Season-of-competition
waiver – competition while eligible.
a. Number
of contests/dates of competition student-athlete participated.
_________________________________________________________________________
b. Please
list dates competition occurred.
_________________________________________________________________________
c. Number
of contests/dates of competition in institution's season.
_________________________________________________________________________
d. Percent
calculation of season.
________________________________________________
e. Which
circumstance of the wavier does the institution believe student-athlete meets?
r Life threatening injury or
illness suffered by a member of student-athlete's immediate family.
r Extreme financial
difficulties as a result of a specific event experienced by student-athlete or
individual on whom student-athlete is legally dependent.
r
Student-athlete's institution dropped the sport.
r
Student-athlete participated as a result of a good faith, reliance on a
coaching staff member's decision to put the student-athlete in an alumni
contest, exhibition contest, scrimmage or nonchampionship season based on the
coach's documented misunderstanding of NCAA legislation.
f. Please
describe reasons institution believes legislation is met and provide any
mitigation that should be considered in reviewing the waiver.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
g. In
addition to the application, the following documentation should be submitted
with the waiver.
r
Student-athlete's complete academic transcript (including all
institutions attended).
r
Written statement from student-athlete describing circumstances
surrounding request.
r
If request is for medical reasons, medical documentation that when analyzed
together, demonstrates that the injury or illness suffered by family member
prevented the student-athlete from competing during the remainder of the
season. (Please note that
contemporaneous medical documentation includes, but is not limited to, doctor's
notes, doctor's evaluations, emergency room records, physical therapy records,
nurse's records and/or records. The
documentation must be from the time of the injury and generally include a
description and diagnosis of the patient's condition.)
r
For financial hardship, documentation should be included to substantiate
the specific event and demonstrate how the specific event prevented
student-athlete from continuing to compete.
r
For matters involving coaching error, please provide documentation from
the coach explaining his misunderstanding of NCAA legislation.
r
A schedule from the season showing which contests the student-athlete
participated.
r
Any other documentation that is relevant to the discussion of the waiver.
h. Please
note that for waivers involving coaching error, if a waiver is granted the
student-athlete will be withheld from competition on a two-for-one basis.
3. Season-of-competition
waiver – competition while ineligible.
a. Number
of contests/dates of competition student-athlete participated.
___________________________________________________________________________
b. Please
list dates competition occurred.
___________________________________________________________________________
c. Number
of contests/dates of competition in institution's season.
___________________________________________________________________________
d. Percent
calculation of season. ___________________________________________________
e. Did
the competition occur within 60 days of the date student-athlete first reported
for athletics participation? _______________________________________________________________
f. Was
the student-athlete innocently involved? ______________________________________
g. Has
the institution also reported this violation to the NCAA student-athlete
reinstatement staff?
_________________________________________________________________________________
h. Please
provide a detailed description of the error that occurred and present any
mitigation that should be considered in processing the request.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
i. In
addition to the application, the following documentation should be included
with the waiver.
r
Written statement from student-athlete describing
circumstances surrounding request.
r
Please provide documentation from the individual
responsible for the error (e.g., appropriate certifying office, coach, etc.).
r
A schedule from the season showing which contests
the student-athlete participated.
r
Any other documentation that is relevant to the
discussion of the waiver.
4. Hardship
wavier – independent institution.
a. Date
of onset of injury or illness.
______________________________________________
b. Number
of contests/dates of competition in institution's season. ______________________
c. Number
of competitions in which student-athlete participated. _______________________
d. Percent
calculation. _________________________________
e. Explain
the circumstances surrounding injury or illness and include any mitigation that
should be considered.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
f. In
addition to the application, the following information should be submitted with
the waiver.
r
Written statement from student-athlete describing
circumstances surrounding request.
r
Medical documentation that when analyzed together,
demonstrates that the injury or illness was "incapacitating" in
nature and prevented the student-athlete from competing during a specific
season. Legislation requires that
documentation must be contemporaneous and include a letter from the treating
physician describing the nature of the injury or illness and whether or not it
was incapacitating. (Please note
that contemporaneous medical documentation includes, but is not limited to,
doctor's notes, doctor's evaluations, emergency room records, physical therapy
records, nurse's records and/or records.
The documentation must be from the time of the injury and generally
include a description and diagnosis of the patient's condition.)
r
A schedule from the season showing which contests
the student-athlete participated.
r
Any other documentation that is relevant to the
discussion of the waiver.