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    Office of Student-Athlete Development

    NC State

    This form, when signed by the promotional agency involved and approved by the Athletic Department, allows the student-athlete's name, picture, or identity to be used in a community service or promotional activity.

    NCAA Bylaw 12.5 promotional activities; 12.5.1 permissible; 12.5.2 nonpermissible

    View Bylaw in PDF Format

    To be completed by the sponsoring agency:


    Name of Sponsoring Agency

    Name of Contact Person
    Address (Street / City, State / Zip)
    Phone Number
    Fax Number
    Date of Event
    Time of Event
    City/State of Event
    Please Describe Your Event
    NCAA regulations preclude members from participating in activities that directly or indirectly benefit any student who has started ninth grade.
    Yes No 1. Is this a fundraising event?
    Yes No 2. Will the funds from the event directly or indirectly benefit prospects? If yes, the University of its representatives may not participate in the event; if no, explains use of the funds:
    Yes No 3. Will the event involve students who have started the ninth grade?
    Yes No 4. Will the involved student-athletes miss class?
    Yes No 5. Will you provide transportation or meals to the student-athlete? Explain:
    I certify that I have read this form and the provisions of NCAA Bylaw 12.5.11 in its entirety and agree to the required terms and conditions.
    Electronic Signature of authorized representative
    Date Signed
    Electronic Signature of student-athlete
    Date Signed

    Note: Submission will send you to details of Provisions of NCAA Bylaw

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