NIL Disclosure Form - Feather River College

Email address *

Cell Phone *

Name *

College/University *

Sport *

Which type of NIL activities will you be participating in? *

Only check the boxes for activities that you will be compensated for (payment, food, etc.)

Appearance/Speaking Engagement Autographs Crowdfunding Operating own camp/clinics/private lessons Outside camp/clinic (not organized by you) Promotion of business/product/service Sale of merchandise/memorabilia Social Media influencer/Ambassador Other (please explain in the next question)

If you selected other in the question above please specify what activity you will participate in that you were/will be compensated for

List all involved parties for the activities in which you were compensated, including any agent representation you may be involved with: *

Names

Business/Company *

Phone/Email *

What are the terms of the agreement? *

What is the start date/time of the agreement? *

What compensation will take place as a result of your participation? *

Will (or were) any institutional logos or trademarks be used for the activity *

Yes No

If yes, did you receive institutional approval *

Yes No

Will (or were) institutional facilities be used for the activity *

Yes No

If yes, did you receive institutional approval *

Yes No

Did anyone from your institution assist you with this arrangement *

Yes No

If yes, who?

If yes, describe their involvement

My signature below affirms that I have disclosed complete and accurate information regarding my compensated NIL activity/activities stated above. I further affirm that I have followed all pertinent CCCAA Bylaws and that it is my responsibility to understand if/how this compensation will impact my financial aid or income tax. *

Name

Date *

* required field