Compliance Forms
Student-Athlete Statement

PLEASE READ AND SCROLL TO THE BOTTOM TO SIGN AND CONFIRM.

By signing this part of the form, you certify that you agree to disclose your education records.

You understand that this entire form and the results of any NCAA drug test you may take are part of your education records. These records are protected by the Family Educational Rights and Privacy Act of 1974 and they may not be disclosed without your consent.

You give your consent to disclose only to authorized representatives of this institution, its athletics conference (if any) and the NCAA, except as permitted in the Drug-Testing Consent form, the following documents:

• This form;
• Results of NCAA drug tests and related information and correspondence;
• Results of positive drug tests done by non-NCAA national or international athletics organizations;
• Any transcript from your high school, this institution, or any junior college or any other four-year institutions you have attended;
• Precollege test scores, appropriately related information and correspondence (e.g., testing sites, dates and letters of test-score certification or appeal), and where applicable, information relating to eligibility for or conduct of nonstandard testing;
• Graduation status;
• Your social security number and/or student identification number;
• Race and gender identification;
• Diagnosis of any education-impact disabilities;
• Accommodations provided or approved and other information related to any education-impact disabilities in all secondary and postsecondary schools;
• Records concerning your financial aid; and
• Any other papers or information pertaining to your NCAA eligibility.

You agree to disclose these records only to determine your eligibility for intercollegiate athletics, your eligibility for athletically related financial aid, for evaluation of school and team academic success, for awards and recognition programs highlighting student-athlete academic success, for purposes of inclusion in summary institutional information reported to the NCAA (and which may be publicly released by it), for NCAA longitudinal research studies and for activities related to NCAA compliance reviews and athletics certification. You will not be identified by name by the NCAA in any such published or distributed information. This consent shall remain in effect as long as any issues regarding the purposes listed above exist.

You also agree that information regarding any infractions matter in which you may be involved may be published or distributed to third parties as required by NCAA policies, bylaws or procedures.

Do you agree to these terms?

Yes     No

Do you have follow up questions for the Compliance Office?

Yes     No