USA RUGBY COLLEGIATE PLAYER ELIGIBILITY FORM 1

PLAYERS 1 THROUGH 15

Name of Club: 

 

Name of Institution:

 

To be completed by the Club

To be completed by the Registrar
 

Alphabetical Student

Listing - (please print)

Student Signature

Student ID #

USA Rugby

CIPP #

Date of

Birth

High School Graduation

Date

Is student

enrolled full

time? (Y or N)

Is student an

undergraduate?

(Y or N)

Is student in

good standing?

(Y of N)

1.

                 

2.

                 

3.

                 

4.

                 

5.

                 

6.

                 

7.

                 

8.

                 

9.

                 

10.

                 

11.

                 

12.

                 

13.

                 

14.

                 

15.

                 

THE REGISTRAR MUST COMPLETE AND SIGN THIS FORM AND AFFIX THE INSTITUTION’S SEAL AS VERIFICATION OF PLAYERS’ ELIGIBILITY.

I verify that the information above is accurate and that this USA Rugby Player Eligibility Form was completed by the University, with the exception of name, signature, Student ID Number, and USA Rugby CIPP Number.

             

Please Print Name of Registrar

Signature

Phone Number

Date

PLACE SEAL HERE

 

As the Supervising Agent, Club Sports Director, Athletic Director, etcetera, I verify that the above named Club/Team is recognized by this institution, in Good Standing, and authorized to represent this University at Local, Territorial, and National Events.

       

Please Print Name and Title

 

Signature

 

Phone Number

Date