Declaration of Pre-Existing Relationship

This form should be completed and submitted to the Athletic Compliance office any time an institutional employee, booster, or any other individual believes he/she has a relationship with a prospective student-athlete (PSA), prospective student-athlete's parents, friends or relatives, student-athlete (SA) or student-athlete's parents, friends or relatives which may result in an NCAA violation if continued.

"PAY" as used in bylaw 12.1.2 includes "preferential treatment, benefits or services because of an individual's athletics reputation or skill or payback potential as a professional athlete, unless such treatment, benefits or services are specifically permitted under NCAA legislation."

"EXTRA BENEFIT", as used in bylaw 16.02.3, "is any special arrangement by an institutional employee or representative of the institution's athletics interests that provide a student-athlete or the student-athlete family member or a friend a benefit not expressly authorized by NCAA legislation."

"RELATIONSHIP", for purposes of this form means the type and frequency of contacts with the PSA or SA (or the PSA/SA parents, friends or relatives) including the number, nature and frequency of activities and events in which you and the PSA/SA (or the PSA/SA parents, friends or relatives) participated.

Institutional Staff Member, Booster, or Individual Name:*

Prospective Student-Athlete (PSA)/ Student-Athlete (SA) or Prospective Student-Athlete/Student-Athlete Parents/Friends/Relatives Name:*

Please select the box that best describes your relationship or status:*

UGA Athletics Staff Member
Parent or Legal Guardian
High School Coach
Booster - a "booster" is an individual, entity, or other organization that has [1] promoted the institution's athletic program (e.g., season ticket holder), [2] donated to the athletics department or a booster organization, [3] assisted or been requested to assist in recruiting, [4] assisted in providing benefits to student-athletes or relatives, [5] otherwise promoted the institution's athletics program.
Agent - an "agent" is any individual who, directly or indirectly, [1] represents or attempts to represent an individual for the purpose of marketing his or her athletics ability or reputation for financial gain; or [2] seeks to obtain any type of financial gain or benefit from securing a prospective student-athlete's enrollment at an educational institution or from a student-athlete's potential earnings as a professional athlete.
Other - Please describe below

If "Other" selected above, please describe your relationship with the PSA/SA (or PSA/SA parents/friends/relatives).*

When did your relationship with the PSA/SA Parents/Friends/Relatives first develop?*

When did the athlete become a prospective student-athlete or enter the 9th grade? (please provide the earliest date)*

Did this relationship develop as a result of the PSA/SA's participation in athletics?*

YES
NO

If "YES" above, please describe when you first met the PSA/SA or his/her parents/friends/relatives, and how the relationship has developed.*

Has your relationship with, or the benefits provided to the PSA/SA (or PSA/SA parents/friends/relatives) changed since the PSA/SA has become a skilled athlete?*

YES
NO

If "YES" above, please describe how the relationship has changed.*

Has your relationship with, and the benefits provided to the PSA/SA (or PSA/SA parents/friends/relatives) been continuous?*

YES
NO

If "NO" above, please list the interruptions in the relationship.*

Please provide specific information regarding the frequency and nature of benefits (housing, meals, entertainment, gifts, vacations, etc.) provided to the PSA/SA (or PSA/SA parents/friends/relatives) during the course of the relationship.

Number of meals at your home.*

Number of visits/stays at your home.*

Number of "away from home" entertainment activities (includes dining out, movies, sporting events, etc.).*

Total value of entertainment activities.*

$0
$1 - 10
$11 - 50
$51 - 100
$101 - 1000
$1001+

Please list examples of entertainment provided to the PSA/SA (or PSA/SA parents/friends/relatives).*

Number of gifts given to PSA/SA (or PSA/SA parents/friends/relatives).*

Total value of gifts.*

$0
$1 - 10
$11 - 50
$51 - 100
$101 - 1000
$1001+

Please list specific examples of gifts provided to the PSA/SA (or parents/friends/relatives)*

My signature certifies that to the best of my knowledge, the above responses are correct. Furthermore, I understand that certain pre-existing relationships under NCAA regulations or unreported pre-existing relationships may cause the above named prospective student-athlete or student-athlete to become ineligible to participate in intercollegiate athletics at the University of Georgia should I provide the PSA/SA, his/her parents, friends, or relatives with impermissible benefits or inducements.

Name*

First Last

Email*

Date*

"PAY" as used in bylaw 12.1.2 includes "preferential treatment, benefits or services because of an individual's athletics reputation or skill or payback potential as a professional athlete, unless such treatment, benefits or services are specifically permitted under NCAA legislation."

"EXTRA BENEFIT", as used in bylaw 16.02.3, "is any special arrangement by an institutional employee or representative of the institution's athletics interests that provide a student-athlete or the student-athlete family member or a friend a benefit not expressly authorized by NCAA legislation."

Please provide specific information regarding the frequency and nature of benefits (housing, meals, entertainment, gifts, vacations, etc.) provided to the PSA/SA (or PSA/SA parents/friends/relatives) during the course of the relationship.

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