UGAAA Drug Testing Notification Form

Student-Athlete Name(Required)

First Last

Sport:(Required)

UGA Student ID Number:(Required)

Cell Phone Number:(Required)

Email Address:(Required)

I declare that I am currently taking or have taken in the immediate past the following medication(s):(Required)

None

Over-The-Counter

Prescription

ADHD medication

Please provide name of medication:(Required)

I declare that I am currently taking or have taken in the immediate past the following nutritional supplement(s):(Required)

None

Other

Please provide name(s) of nutritional supplement(s):(Required)

Medical Amnesty Program

By clicking this button, I acknowledge that I understand the medical amnesty program but I am NOT seeking medical amnesty.

By clicking this button, I am seeking medical amnesty and acknowledge that I may have a problem with drugs and/or alcohol. I am self-referring to the substance abuse treatment team for voluntary evaluation and treatment. I understand that I may self-refer to the Medical Amnesty Program only once during my career as an intercollegiate student-athlete with UGAAA and this cannot be used while actively undergoing treatment for an existing substance abuse violation.

Acknowledgement of Drug Testing Notice

I hereby acknowledge that I have been notified of a drug test under the University of Georgia Athletic Association policy. All drug testing procedures will be consistent with the program as established by the athletic association. I will be prepared to identify myself to the drug testing personnel with a photo ID. I will be expected to provide a saliva sample for the drug test. I understand that failure or refusal to appear will result in disciplinary action according to athletic association policies.

Student-Athlete Name (in Leu of Signature)

First Last

Name

This field is for validation purposes and should be left unchanged.

Contact Us:

1 Selig Circle
Athens, Georgia 30602
(706) 542-9103

UGAAA Drug Testing Notification Form

Medical Amnesty Program

Acknowledgement of Drug Testing Notice

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