NCHSAA MASTER ATHLETIC ELIGIBILITY LIST (Please Type) School: Sport: Street: Men/Women: City: Date of 1st Contest: Name of Contestants Date of of Meets Medical Date Meets LEA Number Meets Meets LEA Check If Alphabetically Last Name, Birth First Requirements Enrolled Attendance Subjects Local Promotion Parents Live – First Name, Entry in Present Requirement Passed Last Minimum Standards In This Middle Initial Yr. 9th Semester (# Of Days Missed Semester GPA Administrative Date of Exam & (✓) Grade Per PowerSchool, (✓) Unit (✓) (✓) Gfeller-Waller if applicable) Form Med Exam GW Form* *Gfeller-Waller Form have signed (GW) must be signed by student and parent; √ indicates both I hereby certify that each person listed has complied in all respects with the requirements for eligibility adopted by the NCHSAA and that documents sustaining each eligibility are on file in the school. student’s Signed: ________________________________________ Coach Date: _________________________ Signed: ________________________________________ Athletic Director Date: _________________________ Signed: ________________________________________ Principal Date: _________________________ HIGH SCHOOL ATHLETIC ELIGIBILITY FORM (CONT.)
NCHSAA MASTER ATHLETIC ELIGIBILITY LIST (Please Type) School: Sport: Street: Men/Women: City: Date of 1st Contest: Name of Contestants Alphabetically – Last Name, First Name, Middle Initial Date of Birth Yr. of First Entry in 9th Grade Meets Medical Requirements Date of Exam & (✓) Gfeller-Waller Form Date Enrolled Present Semester Meets LEA Attendance Requirement (# Of Days Missed Per PowerSchool, if applicable) Number Subjects Passed Last Semester Meets Local Minimum GPA (✓) Meets LEA Promotion Standards (✓) Check If Parents Live In This Administrative Unit (✓) Med Exam GW Form* *Gfeller-Waller Form (GW) must be signed by student and parent; √ indicates both have signed I hereby certify that each person listed has complied in all respects with the requirements for eligibility adopted by the NCHSAA and that documents sustaining each student’s eligibility are on file in the school. Signed: ________________________________________ Coach Date: _________________________ Signed: ________________________________________ Athletic Director Date: _________________________ Signed: ________________________________________ Principal Date: _________________________ HIGH SCHOOL ATHLETIC ELIGIBILITY FORM (CONT.)