Pan Am Trials

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11-12 Team

Any questions regarding this form should be referred to the Collegiate Chair or the USA Synchro Collegiate Program Compliance Committee, or you may contact the Education Director at (317) 237-5700.

Note: International student-athletes competing in the B, C, or D technical categories are required to submit a letter from their federation stating if they have or have not competed on a National Team with in the last two calendar years.  This letter must be submitted with this affidavit prior to competition.

Page 1 of 1
Student Athlete Name
Required
School
Required
Student Date of Birth
Required
Student Home address (street or PO Box)
Required
Student Home City
Student Home State
Required
Student Home Zip
Required
Student Home Country
Required
Most Recent Season Competition Scores
Event
Required
Date
Score
Event
Date
Score
Event
Date
Score
Event
Date
Score
Event
Date
Score
Choose the Category you will be entered in for the 2012-2013 season
Required
A Elements (71.000 or higher, or National Team competitor)B Figures (64.000 to 70.999)
C Figures (59.000 to 63.999)D Figures (58.999 or lower)
Acknowledgement
Required
I acknowledge that I have carefully reviewed and consent to the below statement and affirmations
 

Part I: Statement Concerning Eligibility

By completing this form, you affirm that, to the best of your knowledge, you are eligible to compete in intercollegiate competition. You affirm that your Coach has provided you a copy of the USA Synchro Collegiate Program Manual, or another outline or summary of the collegiate legislation, or the relevant sections of the Manual and that your Coach (or his or her designee) gave you the opportunity to ask questions about them. You affirm that you meet the USA Synchro Collegiate Program regulations for student-athletes regarding eligibility, recruitment, financial aid, amateur status and involvement in gambling activities. You affirm that all information provided to the Collegiate Program, the USA Synchro National Office and the institution’s admissions office is accurate and valid, including ACT or SAT scores, high school attendance, completion of coursework and high school grades, as well as your amateur status. You affirm that you have reported to the Collegiate Chair or her designee of your institution any violations of collegiate regulations involving you and your institution. You affirm that you understand that if you sign this statement falsely or erroneously, you violate USA Synchro Collegiate Program legislation on ethical conduct and you will further jeopardize your eligibility.

Part II: Affirmation of Status as an Amateur Athlete

You affirm that you have read and understand the USA Synchro Collegiate Program amateurism rules. You affirm that, to the best of your knowledge, you have not violated any amateurism rules since the last time you signed a student-athlete statement. You affirm that you have not provided false or misleading information concerning your amateur status to the USA Synchro National Office, the Collegiate Program and the institution’s athletics department, including administrative personnel and the coaching staff.

Part III: Technical Even Affidavit

You affirm that you have read and understand the USA Synchro Collegiate Program Technical category criteria. You affirm that, to the best of your knowledge, you are not violating any part of the technical category rule since the last time you signed a student-athlete statement. You affirm that you have not provided false or misleading information concerning your eligibility in the given category to the USA Synchro National Office, the collegiate program and the institution’s athletics department, including administrative personnel and the coaching staff.

 

    


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