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doc14035 Student-Athlete_Consent_Form.pdf
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Page 1
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1 · FIGURE
2 · TITLE
3 · TEXT
4 · HEADING
5 · LIST
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9 · HEADING
10 · LIST
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15 · TEXT
16 · TEXT
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19 · TEXT
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22 · HEADING
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27 · TEXT
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34 · FOOTER
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"text": "As a member of the National Collegiate Athletic Association (“NCAA”), Kentucky State University (“KSU”) adheres to the NCAA Board of Governors’ Policy on Campus Sexual Violence as revised on or about April 27, 2021, and gathers certain disciplinary and criminal history about incoming and transfer potential student athletes from their former institutions. Prospective student athletes who wish to participate in NCAA intercollegiate athletics must comply with this procedure."
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"text": "and/or criminal information from my educational records to Kentucky State University, including records related to the crimes and incidents addressed in the NCAA Policy on Campus Sexual Violence."
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Page 2
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"text": "If yes to any of the following, please provide further documentation.\n1. Has the student ever been found responsible in a Title IX or related disciplinary proceeding for sexual, interpersonal or other acts of violence?\n2. Has the student ever been criminally convicted for sexual, interpersonal or other acts of violence?\n3. Did the student have a Title IX or related disciplinary proceeding pending for sexual, interpersonal or other acts of violence when the student left the institution?",
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