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MASTER ELIGIBILITY SHEET
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School:Address:
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Sport:City:
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Men/Women:Zip:
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Date of 1st Contest:
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Name of Contestants
Alphabetically - Last Name, First Name, M.I.		Date of Birth
(MM/DD/YYYY)		Yr. of First
Entry in 9th
Grade		Date of Enrollment
for Current School Year
(MM/DD/YYYY)		Meets Medical
Requirements

Date of Exam &
(X) Gfeller-Waller
Form		Passed at Least
70% of the Courses During
the Preceding Semester		Attended At Least 85% of Total Number of Instructional Days in the PSU During the Previous Semester (X)On Track to
Advance to the
Next Grade Level or
Graduate Within the
Next Calendar Year (X)		Meets all
NCSBOE Residence
& Enrollment
Requirements (X)		Meets all
NCSBOE Residence
and/or Transfer
Requirements (X)		Meets all PSU
Eligibility Standards
(GPA, Promotion,
etc.)
(X)
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Med. Exam
(MM/DD/YYYY)		GW Form*Courses
Taken		Courses
Passed		Eligible?
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*Gfeller-Waller Form (GW) must be signed by student and parent; (X) indicates both have signed
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I hereby certify that each person listed has complied in all respects with the requirements for eligibility adopted by the NCHSAA and that documents sustaining each student's eligibility are on file in the school.
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Signed: _____________________________________________ (Head Coach)Date: _______________________
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Signed: _____________________________________________ (Athletic Director)Date: _______________________
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Signed: _____________________________________________ (Principal)Date: _______________________
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NCHSAA MASTER ATHLETIC ELIGIBILITY SHEET (CONT.)
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DATA ON STUDENT-ATHLETES WHOSE PARENTS DO NOT LIVE IN ADMINISTRATIVE UNIT
INSTRUCTIONS FOR COMPLETING THE FORM
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In the section below titled "Reason for Eligibility", insert the appropriate number for the code from Section 1.2.2(e) in the NCHSAA Handbook, thus describing the student's status.
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Name of Student-AthleteAddress of ParentsCode Number for Eligibility
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OFFICIAL TEAM PERSONNEL
(Managers, Trainers, etc.)		HEAD and ASSISTANT COACHES
[Must List All Coaches - Paid and Volunteer]		TEAM COMPLIANCE WITH GFELLER-WALLER
REQUIREMENTS
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NameNameAED/CPR or SCA Exp. DateNCHSAA Eligibility
Video		GW
Form		NFHS
FOC		NFHS
CIS		ITEMCOMPLETION DATE
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EAP DEVELOPED
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EAP ATC REVIEW
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EAP REHEARSED
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EAP POSTED
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RTP DISCUSSED
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PRIN. APPROVED
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MUST BE ON FILE IN DRAGONFLY
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I hereby certify that each person listed has complied in all respects with the requirements for eligibility adopted by the NCHSAA and that documents sustaining each coach's eligibility are on file.
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Head Coach of This Sport:Date Semester Begins:
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Date Semester Ends:
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