NJCAA Eligibility Affidavit

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Fill in all applicable information on this form to assist in determining eligibility for the NJCAA.

Personal Information

Student's Name: *

Date of Birth: *

ID Number:

Student's College Street Address: *

City: *

State: *

Zip Code: *

Phone Number(s) at College: *

Email address *

Other Information

Parents Names:

Parent's Home Street Address:

City: *

State: *

Zip Code: *

Parent's Phone Numbers (Home/Cell/Work)

Foreign Born Students:

Do you have an I-20 Form on file at this college? *

Yes No

High School Information:

Name of High School(s) you have attended:

Address (City, State & Country):

Phone Number:

Address (Street, City, State & Zip Code):

Did you graduate?:

Yes No

High School Graduation Date (Month/Date/Year):

Were you home schooled?

Yes No

Did you graduate?:

Yes No

Did you earn a GED?:

Yes No

GED date earned (Month/Date/Year):

Did you attend three or more years of high school in the United States?:

Yes No

* Please send a COPY of your High School Transcript and GED Certificate (if applicable).

Additional Information:

1. Did you take any college credit classes while in high school?:

Yes No

If yes, from what college(s)?:

*If yes, those transcript(s) from each college must be on file at this college.

2. Have you ever signed a Letter of Intent form with any institution?:

Yes No

If yes, specify the College:

Date (Day/Month/Year):

3. Have you ever participated in a sport in a country other than the United States?:

Yes No

If yes, describe the situation:

Sport(s):

Country: *

4. Have you ever been red-shirted for a season?:

Yes No

Dates: *

If yes, list the dates of that season, name of college, and describe the situation:

5. Have you ever participated in practices, scrimmages, and/or games for an intercollegiate team other than this college?:

Yes No

If yes, name the school, date, sport, and describe the situation:

6. Have you ever played on a club team at a college or university?:

Yes No

If yes, name the school, sport and dates:

7. Do you currently play on any other sport teams (i.e. USAV, city recreational leagues, indoor soccer, AAU, etc.):

Yes No

If yes, list the dates of that season, name of college, and describe the situation:

8. Have you ever received money beyond expenses for participating in any athletic event?:

Yes No

Did anyone on your team receive money beyond expenses for participating in any athletic event?:

Yes No

If yes, describe the situation below and the NJCAA Amateurism Questionnaire should be completed and included with the eligibility file:

List ALL Colleges Attended Full-Time and / or Part-Time after High School

All transcripts from all previous institutions must be inc l uded .

College:

Dates:

Select one:

Full-time Part-time

College:

Dates:

Select one:

Full-time Part-time

College:

Dates:

Select one:

Full-time Part-time

College:

Dates:

Select one:

Full-time Part-time

Additional Explanations:

NOTE: If you attended college part-time or were not attending college for any period of time following high school graduation, please document your employment and military history during those times in the space below. If you were unemployed at any time, please list those dates below. The NJCAA requires that you account for any time not enrolled full-time. Please use the space below. Please record months and years when referring to dates.

I understand that information falsified or omitted can make me ineligible for ALL future college competition in compliance with the National Junior College Athletic Association Eligibility Rules.

Student-Athlete Electronic Signature - Please type your First and Last Name: *

Date: *

Date Picker

Coach Electronic Signature - Please type your First and Last Name: *

Date: *

Date Picker

* required field