Student Athlete Appearance Request & Promotional Activity Form
INSTRUCTIONS: Please have the sponsoring agency complete this form.The following information must be provided in order to determine the permissibility of a student-athlete’s proposed involvement in the activity. Please note, even if an event is permitted by NCAA legislation, the availability of student-athletes is subject to approval by coaches, sports administrators, and the involved student-athlete(s). If you have any questions, please contact the Compliance Services Office at 734-615-7341 or the Let's Go Do team at 734-764-7614.
Sponsoring Agency
*
Agency Contact Name
*
First Name
Last Name
Agency Contact Phone Number
*
Agency Contact Email
*
example@example.com
Agency Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this agency charitable, educational or institutional?
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Yes
No
Is this agency certified as as 501C nonprofit agency?
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Yes
No
What age group does this agency benefit? (Provide ages or grade levels)
*
Purpose of Event/Activity:
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Start Date & Time of Event/Activity
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-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
End Date & Time of Event/Activity
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-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
If the event is longer than one hour, can the commitment for the student-athlete(s) be shortened or split into shifts? Explain.
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Location & Distance from Campus of Activity:
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Number of student-athlete(s) requested? Do you have specific student-athlete(s) or sport(s) requested?
*
Specify the proposed activity and what the student-athlete(s) would do (attach information below, if available):
*
Attach information related to the proposed activity, if available:
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Will money be raised from the activity?
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Yes
No
If YES, who will receive the proceeds and what will the proceeds be used for?
Will there be any commercial sponsorship of the event?
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Yes
No
If YES, how is the commercial entity involved in this activity?
Will there be any advertisement or promotions by a commercial agency or sponsor?
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Yes
No
If YES, what type of advertising or promotion will be used?
Will a student-athlete's name, picture, personal appearance or involvement be used in any advertising or promotion of the activity?
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Yes
No
If YES, how will the student-athlete(s) be used in the advertising or promotion?
Will the student-athlete(s) receive expenses/gifts (e.g., meals, transportation) associated with their involvement in the activity?
*
Yes
No
If YES, indicate what the student-athlete(s) will receive:
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Next - Signature & Terms
Promotional Activities Involving Student-Athletes
The NCAA rules permit a member institution, a member conference or a charitable or educational agency to use a student-athlete’s name, picture or appearance to support its charitable or educational activities, provided the following conditions are met: (1) The student-athlete receives written approval to participate from the Athletic Director’s Designee, subject to the limitations on participants in such activities as set forth in the NCAA regulations. (2) The specific activity or project in which the student-athlete participates does not involve co-sponsorship, advertisement or promotion by a commercial agency other than through the reproduction of the sponsoring company’s officially registered trademark or logo printed materials such as pictures, posters or calendars. The company’s emblem, name, address and telephone number may be included with the trademark or logo. Personal names, messages and slogans are prohibited. The student-athlete’s name, picture or appearance cannot be used in any way that would directly or indirectly imply his/her endorsement of a commercial product or service. (3) The student-athlete does not miss class to participate. (4) All money derived from the activity or project go directly to the institution, charitable or educational agency. (5) The student-athlete may accept legitimate and normal expenses (e.g., for travel and meals) from the institution, or the charitable or educational agency related to the participation in such activity. (6) Items that include an individual student-athlete's name, picture or likeness (e.g., name on jersey, autograph or likeness on a bobble-head doll), other than informational items (e.g., media guide, schedule cards, institutional publications), may not be sold even for permissible charitable causes; and (7) The student-athlete and an authorized representative of the charitable or educational agency must sign this release statement ensuring that the student-athletes name, image or appearance is used in a manner consistent with the requirements of this section.
SPONSORING AGENCY RELEASE STATEMENT: In signing this form I acknowledge that I have read and agree to abide by the above NCAA regulations regarding the use of a student-athlete's name, picture or appearance in the promotion or involvement of this activity.
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I agree
Signature of Authorized Agency Representative
*
Back to Activity Details
Submit for Approval
Next - Admin Only
Michigan Athletics Administrative Approval
Admin Code
Admin - Do you approve this request?
Yes
No
Compliance Code
Compliance - Do you approve this request?
Yes
No
Please provide the reason for the decline.
Submit
Should be Empty: