University of South Carolina Office of Athletics Compliance

Transcription

1 University of South Carolina Office of Athletics Compliance Sports Agent/Advisor Registration Application The completion of this form is required for registration in the University of South Carolina Sports Agent Program. This form must be completed in its entirety. Please print or type. I. General Information Name: Date of Birth: Social Security #: Address: Mobile Phone: Home Phone: Home Address: Street Address Apt/Suite # City State Zip Code If affiliated with a particular firm or agency as a sports agent, please indicate: Name of Firm/Agency: Business Phone: Fax Number: Business Address: Street Address Apt/Suite # City State Zip Code II. Education High School School Name: City Month/Year Graduated: State College (undergraduate) School Name: City State Degree(s) Awarded and Year Graduated:

2 Agent Application 2 Graduate/Legal School Name: City State Degree(s) Awarded and Year Graduated: Admitted to Bar (If applicable) State Date III. Experience Number of years experience as a sports agent: _ Sports in which you currently represent athletes and total number of athletes in each sport: Sport # of Clients IV. Other Qualifications Current memberships in professional organizations: Organization Member Since

3 Agent Application 3 Occupational or professional licenses (e.g. certified public accountant, charted life underwriter) and date obtained: License Date Obtained Are you currently registered by the State of South Carolina as a sports agent? Yes No If yes, what is your South Carolina Agent Registration Number: V. Professional Services General services performed for client-athletes (check those that apply and indicate fee charged): _ Playing Contract Negotiations _Endorsement Contract Negotiations _Legal Assistance _Financial Planning _Tax Consulting _Money Management For the services you perform for client-athletes, list the names and addresses of individuals, firms or agencies that assist in providing these services (use additional sheets if necessary): Name City State Name City State Name City State

4 Agent Application 4 In receiving compensation for contract negotiations services, do you receive payment up front or are payments received as the athlete is compensated? Please explain: Please list the names of any athletes, including University of South Carolina athletes (or all clients, if fewer than 10) you previously or currently represent(ed) and, in team sports, the team/league to which each athlete is currently under contract and name of team representative with whom you negotiated this contract. Write none if you currently do not represent any athlete. If you represent athletes in more than one sport, please provide this information for at least five clients (athletes) in each sport. Use additional sheets if necessary: Player Name Team Client s Phone# Team Representative Please indicate the University of South Carolina student-athlete(s) you plan to contact in the upcoming year:

5 Agent Application 5 Do you earn income form work performed in some capacity other than as a sports agent? Yes No If yes, please explain: VI. Personal Information Have you ever been involved in or accused of participating in any action alleged to have been in violation of NCAA rules, any athletics conference, college or university? Yes No (If yes, please attach explanation) Are any charges or complaints currently pending against you regarding your conduct as an attorney, as a member of any profession, or as a holder of public office? Yes No (If yes, please attach explanation) Have you ever been charged with a criminal offense other than a minor traffic violation? Yes No (If yes, please attach explanation) VII. References Name Title Address: Business Phone: Address: Name Title Address: Business Phone: Address: Name Title Address: Business Phone: Address:

6 Agent Application 6 By signing below, you certify that the above information is true, correct and complete to the best of your knowledge. Further, you certify that you will notify the University of South Carolina Department of Athletics (via the liaison indicated below) before having contact with a student-athlete who has eligibility remaining and is enrolled in the University of South Carolina or before the having contact with the student-athlete s coach. You affirm that you have reviewed the NCAA rules and regulations that accompany this form and have not/will not engage(d) in any activity that would jeopardize a student-athlete s eligibility without first entering into a signed agreement with the student-athlete. You also understand that failure to comply with the terms of this registration, the laws of the State of South Carolina and applicable NCAA legislation may result in the initiation of legal proceedings against you by the University and/or State of South Carolina. Signature: Date: Return Completed Form To: Jamie Funk Assistant Director of Compliance 1300 Rosewood Drive Columbia, SC *If approved, this Sports Agent Registration will be valid for two (2) years from the date of approval, subject to revocation, with notice, at any time by the University of South Carolina. It is the applicant s responsibility to renew this registration prior to expiration. Athletics Dept Use Only Application Status: Approved Denied By: _ Date of Approval/Denial Registration Expires: