Donation Request
Form
Name of the individual or organization making the request: ___________________________________
Contact Individual: ____________________________
Address: ___________________________________
E-Mail Address:___________________
City, State, Zip: _______________________________
Phone Number: ___________________
What type of item(s) is/are being requested? (i.e., *tickets, promotional materials, memorabilia, etc.):
____________________________________________________________________________
* If tickets are being requested—Number of Tickets: ________ Sport: ___________ Date of Game: _____
*Please be advised that the deadline for all group ticket donation requests is one week before the game
What is the purpose of the request? Check the appropriate box:
[ ] Fundraiser [ ] Auction [ ] Giveaway [ ] Promotion [ ] Group Outing
Ages and Grades of individuals who shall benefit from this request: _____________________________
Date of event/activity: _______________________________
Please provide your 501-c3 tax identification number: ______________________________________
NCAA Bylaw 13.15 prohibits all University staff members from participating in the following:
- Donating memorabilia (e.g., jerseys, hats, T-shirts, autographed footballs or basketballs) to any
organization/ event/activity that involves/benefits prospect-aged individuals (9th – 12th *grade and
junior college students). (*7th grade for requests involving anything associated with men’s basketball)
-
Participating in any event in which a donation will be provided to a high school, prep school or two-year
college.
Providing any financial contributions to a high school athletics program by participating in a
fundraising event.
By signing below, you attest that you have read and understand the previously mentioned
NCAA rules regarding impermissible fundraising activities. Furthermore, you agree to follow
all guidelines set forth by NCAA rules.
____________________________
Printed Name of Requestor
______________________
Signature
__________
Date
Please Return Completed Form To:
Justin Bell
Assistant Director, Compliance
Northeastern University Athletics
Fax# 617.373.8988
J.Bell@neu.edu
_____________________________________________________________________
For Athletic Department Use Only: [ ] Request is approved. [ ] Request is denied.
Signature of Compliance Office: _______________
Date: __________________________
Fulfillment Date: _________________________
Record Locator: ___________________