This form is to be completed anytime an institutional employee or athletics booster believes he/she has a pre-existing relationship with a prospective student-athlete, a current Canisius student-athlete, or a parent, friend or relative of either.
Certain actions by institutional employees and/or athletic boosters may be in violation of NCAA bylaws if they are considered to be giving preferential treatment, benefits, or services to an individual because of his/her athletics reputation or potential payback as an athlete. However, if a pre-existing relationship is found to have been established between the employee/booster with the prospect and/or student-athlete, these actions may be permissible provided they have not changed due to the individual’s status as a prospect or student-athlete.
Please answer the following in order to determine if a pre-existing relationship has been established and the nature of such a relationship.
Institutional Employee or Booster
Email Address Phone Number
Zip Code Address City, State
Prospect, Student-Athlete, or Relatives/Friends Of (Please list all names that apply)
When did your relationship with the above individual(s) first develop?
/
When did the athlete in question become a prospect (enter 9 th grade)?
When did the athlete become a collegiate student-athlete (if applicable)?
Month
/
Year
Month
Month
/
Did this relationship develop as a result of the individual’s participation in athletics? Yes
Please describe when you first met the above individual(s) and how your subsequent relationship developed.
Year
Year
No
Has your relationship with this individual changed since he/she has become a prospective or current student-athlete?
If yes, please describe the nature of the change.
Has your relationship with the above individual(s) been continuous?
If no, please list the nature of any interruptions of this relationship.
Yes
Yes
No
No

Please complete the following detailing the nature and frequency of benefits provided to the above individual(s) during the course of your relationship.
Meals provided Never Rarely Occasionally Frequently
Home visits/stays Never Rarely Occasionally Frequently
“Away from home” Entertainment
Ex. dining out, movies, sporting events, etc.
Never Rarely Occasionally Frequently
“Away from home” Entertainment
Ex. Holidays, Birthdays, special events, congratulations, etc.
Travel
Ex. Family vacations, out of town trips, etc.
Never
Never
Rarely
Rarely
Occasionally Frequently
Occasionally Frequently
Please list specific examples of typical benefits provided to the individual(s), the nature/frequency of such benefits, and the value of such benefits.
By signing this document, I certify that to the best of my knowledge, the above answers are complete and accurate.
Furthermore, I understand that if the nature of my relationship is not considered to be “pre-existing” in accordance with
NCAA regulations, certain benefits provided to or the preferential treatment of the above named individual(s) could result in a NCAA violation and potentially affect the eligibility of the prospective student-athlete and/or Canisius studentathlete.
Date Signature of Institutional Employee or Booster
COMPLIANCE APPROVAL
This relationship is considered “pre-existing.”
This relationship does not meet the criteria to be considered “pre-existing.”
Signature of Compliance Director Date