Applicants must complete this form on an annual basis.
Firms / Agencies with multiple applicants must complete a form for each applicant.
Name:
Firm / Agency Name: ____________________________ Firm / Agency Website: _____________________________________
Street Address/City/State/Zip Code: ___________________________________________________________________________
Work Phone: ___________________ Cell Phone: _____________________ Email: __________________________________
Please list all jurisdictions in which you have been admitted to practice law and any pending applications.
Attach additional sheet(s), if necessary.
________________________________________________________________________________________________________
Jurisdiction Status Date
Indicate if you have ever been disbarred, suspended, reprimanded, censured or otherwise disciplined or disqualified as an attorney. Attach additional sheets, if necessary.
________________________________________________________________________________________________________
Date(s) Action Taken Imposing Authority
Authority’s Address
Indicate any charges or complaints currently pending against you regarding your conduct as an attorney.
Attach additional sheets, if necessary.
________________________________________________________________________________________________________
Charge/Complaint Pending Authority Considering
Authority’s Address
All agents applying to communicate with Stanford student- athletes must be registered with the State of California. A copy of such registration, or a notice of pending registration, must be included with this application.

I am registered with the State of California.

My registration application is pending approval by the State of California.
Please provide all current and pending registration information.
Attach additional sheet(s), if necessary.
State: _________ Status: ______________________________ Effective Date: _________ Expiration Date: __________
State: _________ Status: ______________________________ Effective Date: _________ Expiration Date: __________
Have you ever been disciplined or cited for a violation of a state statute regulating athlete agents?
If so, please provide a detailed explanation below. Attach additional sheet(s), if necessary.

Check all that apply and enter requested dates. Attach a copy of your current, valid
registration for each organization selected.

Major League Baseball Players’ Association (MLBPA) Effective Date: _______ Expiration Date: _______

National Basketball Players’ Association (NBPA)
 National Women’s Basketball Players’ Association
(NWBPA)
Effective Date: _______ Expiration Date: _______
Effective Date: _______ Expiration Date: _______

National Football League Players’ Association (NFLPA)

Other: ________________________________
Effective Date: _______ Expiration Date: _______
Effective Date: _______ Expiration Date: _______
Have you ever been disciplined or cited for violating players’ association regulations governing athlete agents? If so, please provide a detailed explanation below. Attach additional sheet(s), if necessary.
______________________________________________________________
______________________________________________________________
______________________________________________________________
: Please list any business associates (e.g., runners, marketing associates, etc.) that work with you or your
firm / agnecy, if applicable:
Name: ____________________________________________ Role with Firm/Agency: _____________________________
Name: ____________________________________________ Role with Firm/Agency: _____________________________
Name: ____________________________________________ Role with Firm/Agency: _____________________________
: Check any of the following situations that apply to you and attach complete information regarding each occurrence, charge, incident, or declaration, including dates, result/status, and authority overseeing the action.
:

Been involved in or investigated for allegedly participating in actions violating NCAA, conference, university, college,
Players’ association, league, team or federation rules?

Yes

No

Been convicted or plead guilty to a criminal charge other than minor traffic violations?

Yes

No

Been a defendant in a civil proceeding, including bankruptcy, involving allegations of fraud, misrepresentation,
embezzlement, misappropriation of funds, conversion, breach of fiduciary duty, forgery, or legal malpractice?

Yes

No

Been suspended or expelled from any college, university, law school or graduate school?

Yes

No

Been declared bankrupt or been an owner or part owner of a business which was declared bankrupt?
D

Yes

No

Been suspended, reprimanded, censured, or otherwise disciplined or disqualified as a member of any professional
organization, or as a public office holder?

Yes

No

If you answered yes to any of the questions listed above, please explain :
________________________________________________________________________________________________

Please identify the services that you or your firm/agency currently offer to athletes (check all that apply):

Playing Contract Negotiations Hourly Fee Charged: $

Appearance / Endorsement Contract Negotiations Hourly Fee Charged: $

Entertainment / Marketing Assistance

Financial Planning
Hourly Fee Charged: $
Hourly Fee Charged: $

Estate Planning

Tax Consulting

Investment Counseling

Grievance Arbitration
Hourly Fee Charged: $
Hourly Fee Charged: $
Hourly Fee Charged: $
Hourly Fee Charged: $
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %
Percentage Charged: %

Insurance Planning Hourly Fee Charged: $ Percentage Charged: %

Insurance Coverage
Please list types of coverage offered:
1.
Do you offer separate contracts for each service?

Yes

No
2.
Do you manage your clients’ funds? 
Yes

No
If yes, please explain:
___________________________________________________________________________
3.
Are you bonded?

Yes

No
If yes, please provide the following information:
Bond Amount: ________________ Company Name: _____________________ Company Phone: _________________
4.
Are you currently registered under the Investment Advisor’s Act? 
Yes

No
5.
Do you refer players to other individuals or firms for services ( e.g., financial planning, etc .)?

Yes

No
If yes, please provide the following information:
Ind. / Firm Name: ___________________ Phone #: ___________________ Service(s): _________________________
Ind. / Firm Name: ___________________ Phone #: ___________________ Service(s): _________________________
6.
Do you receive a fee for referrals?  Yes

No
If yes, please explain the basis for such fees:
7.
Do you (a) have an ownership interest; (b) wholly or partially finance; or (c) directly or indirectly exercise control of
any firm or organization that provides services for players upon your referral?

Yes

No
If yes, please provide the following information:
Firm Name: _______________________ Phone #: ___________________ Service(s): _________________________
Firm Name: _______________________ Phone #: ___________________ Service(s): _________________________

Please list the name and sport of any current Stanford University student-athlete(s) you are interested in contacting:
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
_____________________________________
Student-Athlete Name Sport
You must attach the following information to complete the registration process:

A copy of your State of California Athlete Agent registration, or a notice of pending registration .

A copy of your current, valid registration for all Players’ Associations selected.

A Current Resume/Curriculum Vitae , including, but not limited to, the following information: educational background; employment history; memberships to relevant professional organizations; occupational/professional licenses, date(s) obtained, and state where issued.

A list of your current clients and clients within the past five years . Include the clients name, sport(s) participated in, state(s) where representation/participation took place, the applicable dates of service, and former collegiate institution of each athletes.

A copy of your standard representation contract.

Stanford University Department of Athletics Agent Registration Form will not be processed until all of the required information has been provided.
(You may also send any promotional materials that you would like to have included in your file to be accessible by Stanford student-athletes, coaches, and staff. Please note these promotional materials will not be distributed until you have officially registered with Stanford University and the student-athlete’s season has concluded.)
I have attached all of the documentation requested within this application.
I certify that the information provided in this Stanford University Agent Registration Form is true, accurate, and complete to the best of my knowledge.
I agree to be bound by and conform to California State law, NCAA rules, any other applicable laws, and any Stanford team policy(ies) that may apply to my interaction(s) with a Stanford student-athlete(s). I understand that failure to comply with any of the afore-mentioned authorities may result in the initiation of legal proceedings by Stanford University against me and the assessment of civil and/or criminal penalties.
I certify that I have not engaged in, nor will engage in, any activity that could jeopardize a student-athlete’s collegiate athletics eligibility.
Further, I certify that I will notify the Stanford Compliance Services Office before making contact with a Stanford student-athlete who has eligibility remaining in any sport and is enrolled in Stanford University or before contact with the student-athlete’s family and friends. I will also notify the Stanford Compliance Services Office should any of the information contained in this application change at any point in the future.
I understand that the information contained herein is public in nature and may be provided by Stanford University to its student-athletes, coaches, staff, faculty, families, and others.
_______________________________________________________
Applicant Name (print)
_______________________________________________________
Applicant Signature
______________________
Date
Stanford Compliance Services
Department of Athletics
Stanford University
Arrillaga Family Sports Center
641 East Campus Drive
Stanford, CA 94305-6150
Fax: 650-725-9986
Email: stanfordcompliance@stanford.edu
________________________________________________________
Stanford Compliance Services Signature
__________________________
Date