Medical Hardship Request

Name of Student Athlete:*

Sport:*

Year Requested:*

Did the student-athlete endure an incapacitating injury (as defined by our athletics training staff) in the first half of the competition season that prevented the student-athlete from competing for the remainder of the season?*

Yes
No

Did the student-athlete compete in more than 3 contests or 30% of competition?*

Yes
No

Did the student-athlete compete in the second half of the season?*

Yes
No

Please attach competition schedule with indication of which contests or dates of competition the student athlete competed.

Max. file size: 2 MB.

ACKNOWLEDGEMENT:

All of the above information is complete and correct. Athletic Training will need to submit a letter and medical documentation attesting to the season-ending injury.

Name:*

First Last

Date:*

Email Address:*

ACKNOWLEDGEMENT:

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