UGA Coach/Staff Member Appearance Request Form

Name of organization requesting permission:*

Contact person of organization:*

First Last

Title:*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number:*

Fax Number:*

This organization is:*

Institutional (UGA Sponsored)
High School
Middle School
Touchdown Club
Booster Club
Sports Club
Non-profit/Charity
State Coaches Association
Other

Type of Organization:*

Does your organization provide funding to a non-scholastic team?*

Date of Planned Activity:*

Time:*

Location of Planned Activity:*

Please describe the planned activity and purpose:*

Will any high school-aged individuals be present?*

Yes
No

If this is a coaches clinic, is this clinic being held in association with a high school all-star game (e.g. does the game take place in the same location, same week)?

Yes
No

Coach or staff member requested:*

UGA Athletics Department Staff Contact Name:*

UGA Athletics Department Staff Contact Email Address:*

Are funds being raised at this event?*

Yes
No

Who and what are the funds being raised for?*

Certification

I certify that all of the funds generated by the above named organization/event will not be provided, directly or indirectly, to a high school athletics program. The above named organization will adhere to all NCAA rules listed on the back of this form. 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.

Signature:*

Name of Contact Person:*

Date:*

Contact Email:*

Enter Email Confirm Email

Certification

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