Official Request for Medical Waiver

Email Secondary Email

There are errors with your form submission. Please review and submit again

*Form must be submitted within 30 days of injury*

Email address *

First name *

Last name *

Institution *

Student Name *

Sport *

If you indicated OTHER above, please provide the sport here

Academic Year *

Date of Hardship *

Date Picker

Brief Summary of Hardship *

Number of contests participated in *

Number of scheduled contests *

Include the follwing attachments:

1. Letter from the student athlete describing the hardship in question

2. Letter from the Athletic Director confirming the details of the hardship

3. Copy of published schedule

4. Individual statistics for the season as recorded by the Sports Information Director

5. All other applicable supporting documentation

a. For medicial hardships, this includes documentation confirming a season ending injury

This form does not support file uploads. All supporting documents must be provided by a link, or by emailing eligibility@theuscaa.com with the student athlete name as the subject. Ex: Hardship Waiver - John Smith

To the best of my knowledge, based on the information provided, this student athlete is truthful in their statements and meets the requirements of the USCAA Bylaw 24.12 to be granted a hardship waiver for the academic year of *

Prepared by *

Date *

Date Picker

Signature of Director of Athletics *

By typing the name of the Director of Athletics, you confirm that the above information is complete and accurate.

* required field