This form confirms Vincennes University student-athlete amateur status in accordance with NJCAA regulations.
Title
A short description to explain the nature of a ticket.
NJCAA AMATEURISM QUESTIONNAIRE

Student Information

Are you a returning student athlete?
Are you a returning student athlete?
List the first and last name of the student athlete.
Type the date of birth for the Student-Athlete.
College Name
Vincennes University

Educational Background

Dates Attended Name of Educational Institution Country Tuition Paid By Graduation Date Where Did You Live?

All Athletics Participation

Team Name Team Contact Information League Affiliation Date of Participation Number of Contests Played List Expenses Received
Did you participate with any teams after your 19th birthday or full-time enrollment in college?
Did you participate with any teams after your 19th birthday or full-time enrollment in college?
Did you receive any money above expenses for your participation on any of the teams mentioned?
Did you receive any money above expenses for your participation on any of the teams mentioned?
Did anyone on your team receive money beyond expenses for participating in any athletic event?
Did anyone on your team receive money beyond expenses for participating in any athletic event?
Did you sign any type of agreement to participate on any of the teams mentioned above?
Did you sign any type of agreement to participate on any of the teams mentioned above?
File attachments associated with the ticket.
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List the first and last names of any siblings.
Did any of the teams you participated on call themselves professional?
Did any of the teams you participated on call themselves professional?
John and Lisa Jones, John Jones and Lisa Smith, etc. . .
Did you have a written or verbal agreement with an agent or agency to represent you while you were participating in athletics?
Did you have a written or verbal agreement with an agent or agency to represent you while you were participating in athletics?
Have you or any of your family ever accepted any benefits from an agent or anyone associated with an agent?
Have you or any of your family ever accepted any benefits from an agent or anyone associated with an agent?
Have you ever accepted any benefits not listed on this form from anyone other than your parents?
Have you ever accepted any benefits not listed on this form from anyone other than your parents?
Have you ever been involved in an advertisement or promotion?
Have you ever been involved in an advertisement or promotion?

If you have ever accepted any prize money based on your place finished for your participation in athletics, list them below

Name of Team Date of Competition Name/Type of Competition Prize Money Received Expenses
list contact via by email, letters, telephone calls, in-person visits, etc.
Did you or someone on your behalf ever utilize a recruiting service or another individual to assist you in finding this institution or to assist you in obtaining an athletics scholarship?
Did you or someone on your behalf ever utilize a recruiting service or another individual to assist you in finding this institution or to assist you in obtaining an athletics scholarship?
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.
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.
Acknowledgment & Consent
Clicking Submit signifies that you have thoroughly read and fully understand all the information presented in this form. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.This action is the equivalent of providing your handwritten signature and the current date.

Other Fields

Your name
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