College Athlete Medical Hardship Waiver Form
Submit your request for a medical hardship waiver as a college athlete. Please complete all required sections and acknowledge the waiver statement below.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
College/University Name
*
Sport
*
Please Select
Basketball
Football
Soccer
Track & Field
Baseball/Softball
Swimming
Other
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Injury or Illness
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Briefly describe the nature of your injury or illness and how it impacted your participation.
*
Upload supporting documentation (e.g., medical note, coach letter)
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