Student-Athlete Appearance Request (In-Person or Virtual)

Name of organization requesting permission:*

Organization's Address:*

Street Address City State ZIP Code

Phone Number:*

This organization is:*

Institutional
Educational
Non-Profit (501-C3 of the IRS)

Type of institution:*

K-8
High School

UGAAA coach or staff member contact: (Please make sure that this contact is aware of your request)*

First Last

Email Address of UGAAA coach or staff member:*

Whose appearance is being requested?*

Date of planned activity:*

Time of planned activity:*

Location of planned activity:*

Please describe the planned activity and purpose:*

Will any expenses be provided?*

Will money be raised at this event?*

Yes
No

Where or to whom will the proceeds go, and for what will they be used?*

Will there be co-sponsorship, advertisement or promotion of the event by a commercial agency?*

Yes
No

With whom? Describe printed material or use of logos/trademark.*

If this activity is approved, do you and/or your organization agree to abide by NCAA Bylaw 12.5.1.1?*

Yes
No

12.5.1.1 Institutional, Charitable, Education or Nonprofit Promotions.

A member institution or recognized entity thereof (e.g., fraternity, sorority or student government organization), a member conference or a noninstitutional charitable, educational or nonprofit agency may use a student-athlete's name, picture or appearance to support its charitable or educational activities or to support activities considered incidental to the student-athlete's participation in intercollegiate athletics, provided the following conditions are met:

(a) The student-athlete's participation is subject to the limitations on participants in such activities as set forth in Bylaw 17;

(b) 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 regular trademark or logo on printed materials such as pictures, posters or calendars. The company's emblem, name, address, telephone number and website address may be included with the trademark or logo. Personal names, messages and slogans (other than an officially registered trademark) are prohibited;

(c) The name or picture of a student-athlete with remaining eligibility may not appear on an institution's printed promotional item (e.g., poster, calendar) that includes a reproduction of a product with which a commercial entity is associated if the commercial entity's officially registered regular trademark or logo also appears on the item;

(d) The student-athlete does not miss class;

(e) All moneys derived from the activity or project go directly to the member institution, member conference or the charitable, educational or nonprofit agency;

(f) The student-athlete may accept actual and necessary expenses from the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity;

(g) The student-athlete's name, picture or appearance is not used to promote the commercial ventures of any nonprofit agency;

(h) Any commercial items with names, likenesses or pictures of multiple student-athletes (other than highlight films or media guides per Bylaw 12.5.1.7) may be sold only at the member institution at which the student-athletes are enrolled, the institution's conference, institutionally controlled (owned and operated) outlets or outlets controlled by the charitable, educational or nonprofit organization (e.g., location of the charitable or educational organization, site of charitable event during the event). Items that include an individual student-athlete's name, picture or likeness (e.g., name on jersey, name or likeness on a bobble-head doll), other than informational items (e.g., media guide, schedule cards, institutional publications), may not be sold.

ACKNOWLEDGEMENT

I certify that all of the funds generated by the student-athlete’s name, picture or appearance will be distributed directly to the charitable, educational or nonprofit agency, and that the agency understands and will adhere to all NCAA rules. I understand that it is not permissible for the institution or its representatives to participate in a fund raising activity or event that will benefit any students in grades 9 through 12.

Contact name:*

First Last

Title of Contact:*

Date:*

Email Address:*

ACKNOWLEDGEMENT

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