Community Service/Promotional Request Form

This form, when approved by the Athletics Compliance Office and Director of Athletics, permits a student athlete's name, picture or identity to be used in a promotional or charitable activity for an educational institution or charitable organization. Compliance Office approval often involves follow-up with the promoters, so please allow sufficient time for processing.

*Note: All fields are required.

Name of requesting group/agency:

Request for student-athlete participation in promotional appearance:
Yes
No

Is the agency a(n):
Education Institution
Charitable Organization (Proof of 501(c)(3) status may be requested)

Name of contact person:

Email Address:

Address:

Phone Number:

Location of event:

Date of event:

Time of event:

Detailed Description of event:

Please answer the following questions:

Is the event a fundraiser?
Yes
No

Is the event co-sponsored, advertised or promoted by any commercial agency?
Yes
No

Will any funds raised directly or indirectly benefit any specific high school student?
Yes
No

Will the event involve students who have started classes for the ninth grade?
Yes
No

Is the event within 100 miles of USU's campus?
Yes
No

Are the event organizers providing transportation?
Yes
No

Will the involved student athlete(s) receive a meal?
Yes
No

Will the student athletes' names/appearances be used to promote the event?
Yes
No

Please list all student-athlete names or teams that you would like to participate in your event:

NCAA Bylaw 12.5.1.1 permits a charitable or educational group to use a student-athlete's name, picture or appearance to support a charitable event, provided all of the following conditions are met:

  • The student-athlete receives prior written approval from the athletics director or designee;
  • The student-athlete does not miss class;
  • Any money derived from the activity goes directly to the charitable or educational agency;
  • The student-athletes' names or pictures are not used to promote the commercial ventures of any nonprofit or for profit agency;
  • The name or picture of a student-athlete may not appear on any printed promotional items that include a production of a product with which a commercial entity is associated if the commercial entity's officially registered trademark or logo also appears on the item;
  • 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 student-athlete may accept legitimate and normal expenses from the member institution, member conference or the charitable, educational or nonprofit agency related to participation in such activity, provided it occurs within the state or, if outside the state, within a 100-mile radius of the USU campus.
  • The student-athlete and an authorized representative of the charitable or educational agency sign a release statement that ensures that the student athlete's name, image or appearance is used in a manner consistent with the requirements of this section.

I certify that I have read this form and the provisions of NCAA Bylaw 12.5.1.1 in its entirety and agree to the above terms and conditions.
Yes
No

Verify characters:

Watch Live
Watch Live
Social Media
USU Athletics Official Twitter Feed:

Conservice Maverik Pepsi USU
Utah State University Department of Athletics 7400 Old Main Hill, Logan, UT 84322 Main Phone (435) 797-1850