Athletics NIL Pre-Approval Form

Email address *

First name *

Last name *

Phone number *

Sport(s) *

Baseball Men's Basketball Women's Basketball Men's Cross Country Women's Cross Country Golf Softball Volleyball Women's Soccer

R-Number

Is this a one-time activity? *

Yes No

If yes, please list the start date and end date of activity:

If no, how many activities will you be involved in for this one company (provide number or estimated number, for example, 15 posts):

How will you be compensated for your name, image and likeness activity? Method of payment (check all that apply):

Cash Check Direct Deposit Tips Other

If other, please explain briefly - (i.e. Venmo, PayPal, merchandise, etc.):

Complete one of the following payment choices:

Pay Rate ($/hour) $/Per Post $/Lump Sum $Total Compensation Other

If other, explain (example: athlete kept all clothing used during photoshoot, received merchandise or discount)

How will you travel to the name, image and likeness activity, if applicable?

What is your schedule? Anticipated days of the week the student-athlete will be involved in activities (check each day you will be or likely will be taking part in activities) *

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Name of company compensating you for NIL *

Company's phone # *

Company's street address *

City, State, Zip Code *

Contact person *

Contact person's cell phone number & email *

Brief description of the activity you will be participating in: *

Brief description surrounding the terms of the agreement or transaction *

List all parties to the agreement or transaction, other individuals and entities, and/or professional service providers. If no others were involved in this transaction, please put N/A: *

Please include contact information if applicable.

Were you referred by anyone for this activity? *

Yes No

If yes, who referred you?

Your age *

By submitting this form, I acknowledge that my institution, or a designee of my institution, may review the accuracy of this information, and I consent to any investigation, review, or audit. I acknowledge that inaccurate or incomplete disclosure or failure to cooperate could support a reasonable conclusion that compensation I received constituted an inducement to attend or remain enrolled at a specific school, a substitute for pay for athletics performance or participation, or an otherwise illegitimate source of compensation for use of my name, image, and likeness.

* required field