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Office of Athletic Compliance

This form, when signed by the promotional agency involved and approved by the Athletic Department, allows the atudent-athlete's name, picture, or identity to be used in a community service or promotional activity.

NCAA Bylaw 12.5.1 permissible; 12.5.2 nonpermissible

* = Required field.

To be completed by the sponsoring agency:

*Name of sponsoring agency:

Department/Organization represented (if different than above):

Department/Organization website:

*Agency description (check one): Institutional Charitable Educational

Contact person:

*First Name:
*Last Name:
*Phone Number:
Fax Number:

Event information:

*Date of Event:
Must be in format mm/dd/yyyy

Time requested for student-athlete(s) to be at event:

*Start Time:
*End Time:
*Street Address:
*Zip Code:

*What is the drive time in minutes (one-way) to the event location from the University of Minnesota, Minneapolis campus?:

*Please describe your event:

*Ideally, how many student-athletes would you like at your event:

*Please describe what the student-athlete(s) will do at your event:

NCAA regulations preclude members from participating in activities that directly or indirectly benefit any student who has started ninth grade.

*Is this a fund-raising event?: Yes No

*Will the funds raised from the event directly or indirectly benefit prospects? Yes No
If yes, the University or its representatives may not participate in the event; if no, explain the use of the funds:

*Will the event involve students who have started the ninth grade?: Yes No
If yes, how will they be involved

*Will you provide transportation or meals to the student-athlete?: Yes No
If yes, please explain:

Additional information:

I understand that student-athletes must not miss class for promotional or volunteer activities.

I certify that I have read this form and the provisions of NCAA Bylaw in its entirety and agree to the required terms and conditions.

By checking this box and the “I agree” button below, you certify that you are a representative or appointed individual of the agency listed in this form. Fraudulent submissions are punishable by harsh means.

Please forward all questions or comments to Kaela Anderson, Student-Athlete Development, Intercollegiate Athletics.

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