Donation Request Form

There are errors with your form submission. Please review and submit again
Group/Agency descripton *
Is the event a fundraising event? *
Will the event involve any commercial business or sponsors? *
Will the funds directly or indirectly benefit a group? *
Will the funds directly or indirectly benefit an individual? *
If yes, is that individual a high school student?
Will the event involve students who have started 9th grade? *
Will the money raised go directly to a charity? *
What age group will benefit from the fundraiser/donated items *
I certify that I have read this form and the provisions of NCAA Bylaw 12.5.1.1 (below) in its entirety and agree to the required terms and conditions *
Provisions of NCAA Bylaw 12.5.1.1
NCAA Bylaw 12.5.1.1 permits a charitable or educational agency to use a student-athlete’s name, picture, or appearance to
support its charitable or educational activities, provided the following conditions are met:
(a) The student-athlete receives written approval to participate from the director of athletics (or his or her designee who may not
be a coaching staff member);
(b) The specific activity or project in which the student-athlete participates does not involve co-sponsorship, advertisement or
promotion by a commercial agency other than through the reproduction of the sponsoring company's officially registered regular
trademark or logo on printed materials such as pictures, posters or calendars. The company's emblem, name, address and
telephone number may be included with the trademark or logo. Personal names, messages and slogans (other than an officially
registered trademark) are prohibited;
(c) The name or picture of a student-athlete with remaining eligibility may not appear on an institution's printed promotional item
(e.g., poster, calendar) that includes a reproduction of a product with which a commercial entity is associated if the commercial
entity's officially registered regular trademark or logo also appears on the item;
(d) The student-athlete does not miss class;
(e) All moneys derived from the activity or project go directly to the member institution, member conference or the charitable,
educational or nonprofit agency;
(f) The student-athlete may accept actual and necessary expenses from the member institution, member conference or the
charitable, educational or nonprofit agency related to participation in such activity;
(g) The student-athlete's name, picture or appearance is not utilized to promote the commercial ventures of any nonprofit agency;
(h) Any commercial items with names or pictures of multiple student-athletes (other than highlight films or media guides per
Bylaw 12.5.1.7) may be sold only at the member institution at which the student-athlete is enrolled, institutionally controlled
(owned and operated) outlets or outlets controlled by the charitable or educational organization (e.g., location of the charitable or
educational organization, site of charitable event during the event). Items that include an individual student-athlete’s name,
picture or likeness (e.g., jersey, name or likeness on a bobble-head doll), other than informational items (e.g., media guide,
schedule cards, institutional publications), may not be sold; and
(i) The student-athlete and an authorized representative of the charitable, educational or nonprofit agency sign a release statement
ensuring that the student-athlete's name, image or appearance is used in a manner consistent with the requirements of this
section.(Revised: 1/11/89, 1/10/92)
Note: Apparel items and student-athlete autographs cannot be donated. Also, SIUE student-athletes may not give
recruiting presentations or have direct recruiting contact with any student who has started classes for the ninth grade.
* required field