TO BE USED BY GUIDANCE OFFICES FOR ALL TRANSFERS –
FORWARD THESE SHEETS TO THE ATHLETIC DIRECTOR
STUDENT TRANSFER INFORMATION
All transfers in grades
9-12 must complete this form.
Upon completion,
forward to the Athletic Director.
Student’s name
_______________________________________
Date of birth ________________
Date of
transfer_______________________________________ Grade level _________________
Current Address
______________________________________________________
______________________________________________________
______________________________________________________
Date of entrance into
the 9th grade___________________
Parents’ names
______________________________________________
Current addresses ______________________________
______________________________
______________________________
______________________________
Telephone number(s)
______________________
______________________________
How long has student
resided at the current address? ______________________________
With whom is the
student residing? ______________________________________________
Relationship of this( these) person (s)?
____________________________________________
Reason for transfer?
_________________________________________________________
Student’s previous
address _____________________________________________
_____________________________________________
How long did student
reside at the previous address? ________________________
With whom did student
reside at previous address? ____________________________
Relationship of this
(these) person (s)?
_______________________________________
PREVIOUS SCHOOL __________________________________________________
Previous school
address _________________________________________________
_________________________________________________
Date of entry into
previous school ____________________________________
Did student
participate in interscholastic athletics at previous school?
YES
NO
IF YES PLEASE COMPLETE
SPORT HISTORY PAGE-
TRANSFER
STUDENT SPORT HISTORY
STUDENT NAME________________________________________________________
School transferred
FROM ________________________________________________
LIST
ALL SPORTS AND LEVELS COMPETED IN AT THE ABOVE SCHOOL(S)
YEAR SPORT __LEVEL _____SCHOOL
7th grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
8th grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
9th grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
10th Grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
11th grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
12th grade ________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
________ ____________ ____________ _____________________
ADs
note- Please provide a copy of this form when requesting an ELIGIBILITY WAIVER
for a transfer student.
REQUEST FOR WAIVER OF NYSPHSAA ELIGIBILITY
STANDARD #29 - TRANSFER
INCOMPLETE
OR PARTIAL FORMS WILL NOT BE ACCEPTED
All
pages must be completed in order for the request to be considered…
THIS
PAGE TO BE COMPLETED BY STUDENT’S
Student’s name
_______________________________________
Date of birth ________________
Date of
transfer_______________________________________ Grade level _________________
Current Address
______________________________________________________
______________________________________________________
______________________________________________________
Date of entrance into
the 9th grade___________________
Parents’ names
______________________________________________
Current addresses ________________________ ______________________________
________________________
______________________________
Telephone number(s)
______________________
______________________________
How long has student
resided at the current address? ______________________________
With whom is the
student residing? ______________________________________________
Relationship of this( these) person (s)?
____________________________________________
Reason for transfer? _________________________________________________________
(attach
supporting material and documentation- i.e. transfer history, transcript etc.)
TO BE SIGNED BY SCHOOL
ADMINISTRATORS OF SCHOOL WHERE STUDENT IS CURRENTLY ENROLLED AFTER RECEIPT OF
PAGE TWO FROM THE STUDENT’S PREVIOUS SCHOOL.
The undersigned hereby
certify that the student named herein has transferred to his/her present school
without inducement, recruitment or having sought an athletic advantage.
Superintendent’s
Signature ________________________________________ Date _____________
Principal’s Signature
______________________________________________ Date _____________
Athletic Director’s
Signature _______________________________________ Date ____________
APPROVED Signature
_____________________________
Date____________
Fred
Ahart
Section
IX Eligibility Chairperson
DISAPPROVED
REFERRED TO THE ELIGIBILITY
COMMITTEE
Page TWO
TO BE COMPLETED BY
SCHOOL STUDENT PREVIOUSLY ATTENDED AND RETURNED TO STUDENT’S
Student’s name
_______________________________________
Name of school
attended prior to transfer__________________________________________________
Address of prior
school ____________________________________________
____________________________________________
Date of entrance into
this school ____________________
Date of entrance into
the 9th grade___________________
Date of withdrawal from
this school __________________
Reason for withdrawal
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Student’s address
while attending the above school
______________________________
______________________________
With whom did the
student residing? ______________________________________________
Relationship of this( these) person (s)?
____________________________________________
Did student
participate in interscholastic athletics at previous school ? YES __________ NO ________
If YES please
complete Sport History Page.
The undersigned have
no knowledge that the student named herein has transferred to his/her present
school with inducement, recruitment or having sought an athletic advantage.
Superintendent’s
Signature ________________________________________ Date _____________
Principal’s Signature
______________________________________________ Date _____________
Athletic Director’s
Signature _______________________________________ Date ____________
If unsigned please
state reason
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SECTION IX DURATION OF
COMPETITION EXTENSION APPLICATION
TO BE FORWARDED TO THE
ELIGIBILITY COMMITTEE
I. PERSONAL DATA
Student’s name _______________________________________ Telephone #________________
Current Address
_______________________________________
Grade level ______________
Age
__________________________________________________ Date of birth_______________
School ________________________________________________________
School phone #
_________________________________________________
Seasons and sports
requested ________________________________________________________
Pupil’s Athletic
History
Number
of seasons School
Sport participated years
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
II. Date of Entry (Beginning of Sport Participation in High
School Level of Competition ) Attach Transcript
A.
Date of Entry into 9th
Grade ________________________________________
Month Day Year
B.
Date of Entry into 8th
grade________________________________________
Month Day Year
C.
Date of Entry into 7th
grade_________________________________________
Month Day Year
III.
Reason for Request for
Extension
Describe
the reason for requesting an extension for duration of Competition as it
related to the appropriate circumstances. You may attach supporting documents.
A.
Illness-____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
B.
Accident-
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
C.
Other Circumstances
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Superintendent’s
Signature ________________________________________ Date _____________
Principal’s Signature
______________________________________________ Date _____________
Athletic Director’s
Signature _______________________________________ Date _____________
Parent’s Signature
_________________________________________________Date _____________
APPROVED Signature
_____________________________
Date____________
Fred
Ahart
Section
IX Eligibility Chairperson
DISAPPROVED