arizona state university athlete agent application

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ARIZONA STATE UNIVERSITY
Print Form
ATHLETE AGENT APPLICATION
Submit by Email
GENERAL INFORMATION
Name
Date of Birth
Home Address
Street Address
State
City
Home Phone
Zip Code
Cell Phone
Email Address
If you are affiliated with a Law Firm/Agency/Company, please indicate below:
Name of Firm/Agency/Co.
Business Address
Street Address
City
State
Business Phone
Zip Code
Fax
Business Email Address
Website
EDUCATIONAL BACKGROUND
Undergraduate Institution
School Name
City
Degree(s) Earned
State
Graduation Year
Graduate/Legal Institution
School Name
City
Degree(s) Earned
State
Graduation Year
Graduate/Legal Institution
School Name
City
Degree(s) Earned
Admitted to State Bar
State
Date Admitted
State
Graduation Year
Yes
State
No
Date Admitted
Page of
State
Date Admitted
ARIZONA STATE UNIVERSITY
ATHLETE AGENT APPLICATION
QUALIFICATIONS
Number of Years as an athlete agent
Sport(s) in which you currently represent athletes:
Current membership(s) in professional organizations:
Occupational or professional license(s), state(s) of issuance, and date(s) obtained:
Are you currently certified by any of the following Associations?
Check all that apply.
NFLPA
Type:
Effective Date
Expiration Date
Effective Date
Expiration Date
Effective Date
Expiration Date
Effective Date
Expiration Date
Effective Date
Expiration Date
Effective Date
Expiration Date
Provisional, permanent, general, limited, etc.
NBPA
Type:
Provisional, permanent, general, limited, etc.
MLBPA
Type:
Provisional, permanent, general, limited, etc.
WNBAPA
Type:
Provisional, permanent, general, limited, etc.
Other:
Type:
Provisional, permanent, general, limited, etc.
Other:
Type:
Provisional, permanent, general, limited, etc.
*Attach a copy of your current, valid registration for each organization checked*
No
Yes
Are you currently registered as an athlete agent in the state of Arizona?
*If you answered yes, please attach a copy of the completed registration from the Arizona Secretary of State's office.
If you answered no, you will need to register with the State of Arizona before you will be permitted to register as an
athlete agent with Sun Devil Athletics.*
Date of Certification in the State of Arizona
Have you ever been suspended or disciplined by any player's association, sports league, state regulatory body,
Professional Sports Counseling Panel, bar association, or other appropriate entity?
No
Yes
If you answered yes, please describe. Use additional sheets if necessary:
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ARIZONA STATE UNIVERSITY
ATHLETE AGENT APPLICATION
QUALIFICATIONS (continued)
Have you ever been convicted of a crime other than minor traffic violations?
If you answered yes, please describe. Use additional sheets if necessary:
Yes
No
Have you ever been a defendant in a civil proceeding including bankruptcy or involving allegations of fraud,
misrepresentation, embezzlement, misappropriations of funds, conversion, breach of fiduciary duty, forgery, or legal
malpractice?
No
Yes
If you answered yes, please describe. Use additional sheets if necessary:
Please provide the following information for all of the athletes and coaches you are now representing or have
represented in the past five years in individual contract negotiations with professional sports teams. If the total of
your clients for this time period exceeds ten, list only your present and former clients in any sport in which you are
seeking to represent an Arizona State University student-athlete. If you prefer, you may attach a separate list that
includes this information.
Player/Coach Name
Team
Dates of Representation
Please identify your areas of expertise in reference to professional/agent representation:
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ARIZONA STATE UNIVERSITY
ATHLETE AGENT APPLICATION
BUSINESS INFORMATION
Do you have employees and/or business associates (e.g., runners, marketing associates, etc.) with whom you or
your company work(s)?
No
Yes
If yes, please complete the following for all employees and/or business associates. Use additional sheets if
necessary:
Name
Services Provided
Name
Services Provided
Name
Services Provided
Please check all services that you or your firm offer:
Contract Negotiations
Financial Planning
Investment Planning
Estate Planning
Appearances/Endorsements
Grievance/Arbitration
Insurance Coverage
Tax Planning
Do you offer separate contracts for each service?
Yes
No
Do you manage client funds?
If yes, please explain:
Yes
No
Do you offer referrals for services?
Yes
No
Do you receive a fee for referrals?
If yes, please explain:
Yes
No
In receiving compensation for contract negotiations, do you receive payment "up front" or are your payments
received as the player is compensated?
OTHER INCOME
Do you earn income from work performed in some capacity other than as a athlete agent?
If yes, please describe your other occupations or services. Use additional sheets if necessary:
Page of
Yes
No
ARIZONA STATE UNIVERSITY
ATHLETE AGENT APPLICATION
PREVIOUS EMPLOYMENT
Please list your last two positions and dates of employment:
Employer
Position
Dates of Employment
Employer's Address
Employer Phone
Street
City
State
Zip Code
Reason for leaving:
Employer
Position
Dates of Employment
Employer's Address
Employer Phone
Street
City
State
Zip Code
Reason for leaving:
REFERENCES
Reference Name
Relationship
Employer/Occupation
Address
Street
City
State
Zip Code
State
Zip Code
State
Zip Code
Phone Number
Relationship
Reference Name
Employer/Occupation
Address
Street
City
Phone Number
Relationship
Reference Name
Employer/Occupation
Address
Street
City
Phone Number
Page of
ARIZONA STATE UNIVERSITY
ATHLETE AGENT APPLICATION
By signing below, I certify that the above information is true, correct and complete to the best of
my knowledge. Furthermore, I certify that I will notify the Vice President of University
Athletics or his designated representative, the ASU Athletics Compliance Office, before my or
my office's first contact with (1) a student-athlete who has eligibility remaining in any sport and
is enrolled at ASU or (2) the student-athlete's family or friends. I also certify that I have
reviewed the Arizona Uniform Athlete Agents Act, NCAA agent legislation, and Arizona State
University Agent Policy and have not engaged and will not engage in any activities that would
violate the regulations referred to herein or otherwise jeopardize a student-athlete's eligibility. I
also understand that failure to comply with the terms of this certification, any applicable ASU
Agent Policy, NCAA legislation, or State law may result in the revocation of my agent
registration with ASU, as well as the initiation of legal proceedings by ASU against me.
Signed
Date
If submitting this form by Fax, please fax to:
If submitting this form by by Email, please send to:
For Compliance use only:
480-965-0177
[email protected]
Print Form
Date received:
Initials:
Date entered/conf.:
Initials:
AZSOS Date:
Initials:
Submit By Email
Page of
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