Post Grad Student-Athlete Commitment Statement For: Post Grad student athletes participating on teams who are members of the NPGAAAction: Each Student Athlete is required to sign and submit forms to be eligible to participate within the NPGAADue Date: Submit by determined date during the 2024-25 year.Required By: NPGAA Compliance CommitteePurpose: Identify clarification towards students post high school eligibility.Effective Date: Each post grad student athletes form will take effective on the date signed. The NPGAA post grad student commitment statement will be an active commitment by the student’s signature committing to take part in Post Grad athletics for a period of one calendar year from the time this form is signed.Full Name *Age *DOB *MaleFemaleStreet Address *City *State *Zip *Phone *Cell/Alternate *Email Address *Post Grad Program Enrolled *St *Current year *Sport(s) *The NPGAA has established its commitment to continue to service the Post Grad / College Prep student population with honesty and integrity to the many different sports offered. As a level of commitment within the NPGAA Post Grad student athletic compliance, each Post Grad student athlete will be required to complete the eligibility forms provided before any participation within its Post Grad per-collegiate competition each academic year. Once forms have been approved and verified by the NPGAA Compliance Committee each student will receive their participation verification ID. This ID is to be displayed at each game for verification purposes.PLAYER HEADSHOT *Choose FileNo file chosenDelete uploaded filePLAYER STATE IDENTIFICATION (DL or ID) *Choose FileNo file chosenDelete uploaded file➢ Player Headshot Photo➢ NPGAA Student Athlete Pre-Collegiate Commitment Summary➢ Precondition Eligibility Statement➢ Second Year Returning Post Grad Student Athlete➢ NPGAA Eligibility Affidavit➢ FERPA/HIPAA Consent➢ Student Commitment AgreementNPGAA Student Athlete Pre-Collegiate Commitment Summary NPGAA Bylaws IV. Compliance Student Eligibility Section: states that any student who fails to complete and sign the annual eligibility Post Grad Student-Athlete Commitment Statement shall result in the student-athlete’s ineligibility for participation in all NPGAA per-collegiate post grad competition. By signing all forms provided by the NPGAA each student athlete has read and agreed to all statements and information presents which is to be true to the best of his/her knowledge below in order to be eligible to participate in all NPGAA per-collegiate post grad competition for the current year. Each student athlete is required to read the NPGAA general eligibility Bylaws and guidelines before signing the provided forms regarding eligibility provisions to take part in any per-collegiate post grad competition within the NPGAA. It is the responsibility of each student athlete to read and understand the information provided by the NPGAA. If there are any questions, please consult with your program’s director or academic department for clarification. While all student athletes are given a fair stance to take part with in any NPGAA per-collegiate post grad competition it must be noted that each student must meet the general requirements listed below and sign and submit all requested documents within a timely manner. Precondition Eligibility Statement I acknowledge the following: 1. My current Post Grad organization has provided me with a copy of the NPGAA general eligibility guidelines, rules and regulations as stated within its bylaws as well as code of conduct. 2. Information has been explained thoroughly and that I have been given an opportunity to ask questions that pertain to my eligibility and participation within the NPGAA. 3. After carefully reading all documents presented, I have acknowledged that I have met all qualifications to become eligible to participate as a student athlete within the NPGAA per-collegiate post grad competition including those related to eligibility, ethical conduct, recruiting, & amateurism. 4. That I understand that by signing these forms and statements presented if I knowingly falsify or misleading my current post grad program, I will be in violation of the NPGAA general eligibility guidelines, rules and regulations which may jeopardize my eligibility to participate within the NPGAA per-collegiate post grad competition. NPGAA Second Term Affidavit The National Post Grad Athletic Association Eligibility and Compliance Department is committed to upholding the bylaws and policies established by the NPGAA Board of Directors and its compliance committee. As we are committed to continuing to serve our Post Grad student athletic population our compliance committee is focused on providing opportunities to the student’s athletes in pursuit of a collegiate sports scholarship. The NPGAA and its committees are focused on the growth of post grad as we seek to continue to educate through interactive seminars and on-site workshops that are geared towards educating our member programs of the key eligibility requirements for students seeking a second term.NPGAA Student Eligibility AffidavitSport *Date *Fill in all applicable information on this form to assist in determining eligibility for the NPGAA.NameBirth Date *Social Security # *NCAA ID # *(NCAA Eligibility Center: https://web3.ncaa.org/ecwr3)All student athletes seeking to participate within the NPGAA must provide a valid NCAA ID for eligibility verification.Street Address *CityStateZIP / Postal CodePhone Number(s) *Email Address *Personal Information:Home Address *CityStateZIP / Postal CodePhone Number(s) *Parents' Name *Are You a United States Citizen or a Permanent Resident? *YesNo(*Holder of a Green Card or F1 Visa)Are you on another type of VISA? *YesNoIf so, What type?High School Information: School Name *City *State *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweGraduated? *YesNoHs DiplomaGED* Enclose a COPY of your High School Diploma or GED CertificateDate *Additional Information:1. Did you take any college credit classes while in high school? *YesNoHow many credits *If yes, from what college(s) *If yes, please furnish transcript(s) from each college.2. Have you ever attended and taken any college classes on a full-time basis? *YesNoIf yes, specify the College *Date *3. Have you ever signed a Letter of Intent form with any college institution? *YesNoIf yes, specify the College *Date *4. Have you ever dropped or withdrew from any college classes? *YesNoIf yes, specify before or after the add/drop period *Date *5. Have you ever participated in a college sport in a country other than the United States? *YesNoIf yes, describe the situation and complete the following *Sport(s)? *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweDates *6. Have you ever been red-shirted for a season? *YesNoIf yes, list when, where, and describe the situation did you play during this time. *7. Have you ever participated in practices/tryouts/exhibitions/scrimmages/games for an inter collegiate team other than this college? *YesNoIf yes, name the school, date, sport, and describe the situation. *8. Have you ever played on a club team at a college or university? *YesNoIf yes, name the school, sport, and the dates. *9. Have you ever received money beyond expenses for participating in any athletic event? *YesNoIf yes, describe the situation. *List ALL Colleges Attended Full-Time and/or Part-Time after High School All transcripts from all previous institutions must be included.Collage *Date *Full-timePart-timeCollageDateFull-timePart-timeCollageDateFull-timePart-timeCollageDateFull-timePart-timeAdditional Explanations: NOTE: If you attended college part-time or were not attending at all for any periods of time following high school graduation, please document your employment, military history and or mission work during those times. If you were unemployed at any time, please list those dates as well. The NPGAA requires that we account for any time not enrolled full-time. Please use the space below. Please record months and years when referring to dates.HIPAA/FERPA Uses and Disclosures of Student-Athlete Protected Information Form FAQ’s What is this form? This form was developed based on the Health Insurance Portability & Accountability Act of 1974, 1996 (HIPPA) and the Family Education Rights and Privacy Act of 1974 (FERPA). 1.) FERPA FERPA is a federal law that protects the privacy of student education records. The Family Education Rights and Privacy Act was enacted by Congress to protect the privacy of student educational records. This privacy right is a right vested in the student. Generally: Institutions must have written permission from the student in order to release any information from a student's educational record. Institutions may disclose directory information in the student's educational record without the student's consent. It is good policy for the institution to notify the student about such disclosure and to seek the written permission of the student to allow disclosure of any educational records including directory information. Institutions should give the student ample opportunity to submit a written request that the school refrain from disclosing directory information about them. Institutions must not disclose non-directory information about students without their written consent except in very limited circumstances. Institutions should notify students about their rights under FERPA through annual publications. When in doubt, it is always advisable to err on the side of caution and to not release student educational records without first fully notifying the student about the disclosure. 2.) HIPAA HIPAA was enacted by the U.S. Congress in 1996 to address the security and privacy of health data. This piece of legislation was put into place for many reasons including the following: Insure health insurance portability. Reduce healthcare fraud and abuse. Guarantee security and privacy of health information. Enforce standards for health information MAINLY, to protect health information from disclosure. **This legislation unintentionally impacted athletics because of the medical aspect of care** 1.) Why do we have this form? By signing this form the student-athlete is authorizing their direct supervising Certified Athletic Trainer/Team Physician and/or Insurance Coordinator (Sports Medicine Staff) to communicate with the identified entities as explained in this document when it pertains to the individual throughout the year. ****This does not mean that ANY and/or ALL of medical information can and will be disclosed. The only information that will be disclosed is that of absolute necessity per situation.**** In Example: For Insurance Purposes: Insurance coordinator to correspond with insurance companies to facilitate outside care. This may include but is not limited to: preauthorizing diagnostic testing, surgeries, ensuring proper insurance protocol to coordinate referral appointments as needed. For the Coaching Staff: If an injury occurs during a practice or competition, this form authorizes the Sports Medicine Staff working with your son or daughter to communicate with the coach regarding the status of return. For the Media: It is not our policy to inform the media of any injury or illness conditions without prior consultation with the student-athlete. 2.) Who discloses what information and to whom? The only people who are authorized to disclose information are the student-athlete’s Certified Athletic Trainer, Team Physician or Insurance Coordinator as it pertains to the situation that may arise. See examples above. Any information about past injuries/conditions will only be disclosed as it would pertain to participation in the present. In example: Low back injuries that would limit weight training or conditioning.PART II: FERPA CONSENT. The Family Educational Rights and Privacy Act of 1974 (“FERPA”) gives you certain confidentiality rights with respect to your education records. Generally, the NPGAA must have your written permission before it may release any confidential information from your education records. There are, however, exceptions. For instance, the NPGAA can release “Directory Information” about you without your consent. Directory Information is information that would not be considered harmful or an invasion of privacy if disclosed. Examples include your name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. Subject to the limitations of this Consent Form, the NPGAA and its affiliates seeks to release limited relevant information about you to meet its obligations to the NPGAA and its affiliate athletic or academic organizations in which it participates, or for federally mandated reporting purposes. In addition, the NPGAA seeks your consent to make limited releases regarding your ability to participate in athletic programs or to correct inaccurate statements made by the media, including information related to suspensions or dismissals from a team. Although you may specifically authorize such releases, the NPGAA may elect not to release such information at its discretion. Based on the foregoing, I,, agree that the NPGAA and its affiliate member programs and its employees, agents or representatives (the “NPGAA”) may release, as set forth in this Consent Form, information including, but not limited to, educational records otherwise protected from disclosure under FERPA, as follows: Release of Educational and Sports Information I authorize the University to release information in any way related to my: Eligibility to participate in intercollegiate athletics Class schedule and class attendance College in which enrolled Health and injury status Any other information pertinent to my educational or athletic needs Eligibility for scholarship or financial aid Grades (including semester or cumulative grade point average) Physical ability to participate Suspensions or dismissals from a team I authorize the release of this information to the following persons, agencies, and entities: The National Collegiate Athletic Association (NCAA), National Association of Intercollegiate Athletics (NAIA), National Christian College Athletic Association (NCCAA), United States Specialty Sports Association (USSAA), National Junior College Athletic Association (NJCAA) or any other nationally recognized reputable collegiate or college-affiliated athletic association or their authorized representatives. Authorized representative(s) of any team or group that has been, is, or will be in professional or amateur competition utilizing athletes who either attend the one of the college-affiliated athletic association or whose athletic eligibility has expired (including but not limited to national sport governing bodies, professional league representatives and/or player associations); Federal or state agencies or other entities authorized to receive such information under FERPA. Release of Sports Information I authorize the NPGAA to release my: photograph; birth date and place of birth; athletic statistics; and summary statements related to my class, college, eligibility status, medical ability to participate, health and injury status, any suspensions or dismissals from a NPGAA member team, I authorize the release of this information to the media, my parent(s) and/or legal guardian(s), and to the public through announcements, press releases, NPGAA publications or other reputable record books, statistical compilations, seasonal series or game programs or prospectuses. The NPGAA may make releases about me orally, or by copy, extract, or summary statements, or in such other manner as required by NPGAA rules or the regulations of recognized and reputable associations of which the NPGAA is a member, including historical reports, statements of permissible financial aid and financial assistance, certificates of eligibility and scholarship, squad lists, and affidavits relative to participation or eligibility. I understand that the NPGAA has the option to release the above information and it may choose not to release some or all of that information at its sole discretion. 4. Waiver of Rights With Respect to Athletic Performances and Appearances In connection with any release of personal information about me as set forth in this Consent Form, as well as athletic performances and personal appearances, I consent to the release of any photographic, film, video or other multi-media formatted or sketched representation, name, likeness or appearance of me, either individually, or as a member of a group, and forever waive any rights of publicity or copyright in such released personal information, performances and appearances. 5. Voluntary Waiver of FERPA Rights I understand that I am not required to waive my rights under FERPA as a condition of admission to NPGAA programs or for the receipt of services or benefits from the NPGAA. This Consent is voluntarily given for the entire period of my athletic participation as a Post Grad student athlete participating on a team that is an official member of the NPGAA and I may revoke it only by written letter to the NPGAA. HIPAA CONSENT I,hereby authorize National Post Grad Athletic Association (NPGAA)(Name of Student-Athlete) and its physicians, athletic trainers, and health care personnel to disclose my protected health information including, without limitation, any information regarding any injury, illness, treatment or participation related to or affecting my training for and participation in intercollegiate athletics to the NPGAA, and its designated employees, agents and/or contractors. I further authorize the NPGAA to disclose, and/or use, such information as provided herein. I understand that my participation and protected health information may be disclosed to, and/or used by, the NPGAA, and authorized third parties to receive such information for the purpose of using injury, relevant illness and participation information collected from multiple student-athletes and institutions in a manner that does not identify myself or my school. The information is provided to NPGAA committees, athletics conferences and individual schools, and NPGAA approved researchers to evaluate the effectiveness of health and safety rules and policy, and to study other sports medicine questions. Selected de-identified summary (aggregate) data also are made accessible to the general public as a service to further the general understanding of athletic injury patterns and help develop education on student-athlete health topics. I am making this authorization/consent voluntarily to release my health information otherwise protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment). The NPGAA and its affiliates are not requiring this authorization/consent to be signed. I understand that while HIPAA regulations may not apply to NPGAA use or disclosure of my injury/illness information, the NPGAA is committed to protecting my privacy. I understand that my data will be stored securely within industry standards. This authorization/consent for transfer of protected health information expires 545 days from the date of my signature below, but I have the right to revoke it in writing at any time by sending written notification to the director of athletics at my institution. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date.NPGAA Student Commitment Agreement Each post grad student-athlete shall sign a statement in this form provided by the NPGAA Compliance Department in which the student athlete submits information related to his/her amateur status, state of past and present per-collegiate eligibility, academic and medical status, and recruitment. This will be an annual form prescribed by the NPGAA Compliance Department and it includes the following parts: Please check each box below which states you have read and understand the information provided to you by your post grad administrator or coach. Please check each box:Player Headshot PhotoPrecondition Eligibility StatementSecond Year Returning Post Grad Student AthleteNPGAA Eligibility AffidavitFERPA/HIPAA ConsentStudent Commitment AgreementSTUDENT-ATHLETE SIGNATURE TO BE READ BY COACHES TO PLAYERS ONCE FORM IS COMPLETED BY STUDENT ATHLETE: I agree that I have had an adequate opportunity to read the entire form that I have just completed, and I also understand my right pertaining to the release of my academic and athletic information. I also understand that students seeking a second athletic Post Grad term within the NPGAA shall be required to provide documents as well as acknowledgment that they understand their eligibility rights and they acknowledge that they understand they will lose a year eligibility by participating in a second year of Post Grad. I understand that my signature below reflects my understanding and information falsified or omitted can make me ineligible for all future Post Grad competitions in compliance with the National Post Grad Athletic Association Eligibility Rules.Student-Athlete Signature *Date *Student-Athlete Print *Date *Signature of parent or legal guardian if under (18) *Date *Submit