Form CSCT 2015-16
Confirmation of Sickle Cell Trait Status
2015-16 Academic Year
Effective August 1 st , 2013, all new NCAA participants are required to show proof of their sickle cell trait status. This legislation was passed at the NCAA Convention in January 2013. In compliance with this regulation, and in order to help protect student athletes, Franciscan University requires all varsity athletics participants to provide proof of their sickle cell trait status prior to any form of athletic participation.
The purpose of this form is for the student-athlete to confirm their sickle cell trait status. The studentathlete can do this is one of two ways:

Provide existing documentation of previous test results (most states in the U.S. require this test at birth). These results can be acquired from your family physician or the hospital where you were born.
OR

Have the test done and attach the results to this form.
Student-Athlete must attach a copy of Sickle Cell test results to this form in order to complete testing requirement.
Please check ONE of the options below:
I have attached proof of my sickle cell trait status.
I am a returning student-athlete. I have previously fulfilled the requirements of sickle cell testing.
__________________________________________
Name of Student (typed or printed) Student
_________________________________________
Signature of Student
__________________ ____________________
Student ID#
___________
Date
_________________________________________
Signature of Parent or Guardian
(required if student is under 18 years of age)
___________
Date
Please return this form to:
Franciscan Athletic Department Attn: Kelly Gaughan
1235 University Blvd. Steubenville, OH 43952
Fax: (740) 283-6437
Sport(s)
Last Updated: May 11, 2015