Student Athlete Sexual Violence Attestation Form

Requirements

1. Who:
All prospective (first year), incoming (transfer) and returning student-athletes.

2. When:
Every year of intercollegiate athletics participation (includes tryout, practice and competition).

3. What:
Attest (disclose) if the prospective/incoming/returning student-athlete has been disciplined through a Title IX or sexual misconduct proceeding or criminally convicted, regardless of the degree, and whether the result of a plea or court determination, of either of the following:

Sexual Violence: A term used to include both forcible and nonforcible sex offenses, ranging from sexual battery, sexual assault to rape.
Interpersonal Violence: Violence that is predominantly caused due to the relationship between the victim and the perpetrator, including dating and domestic violence.
Other Acts of Violence: Crimes including murder, manslaughter, aggravated assault or any assault that employs the use of a deadly weapon or causes serious bodily injury.

Attestation

I attest that I HAVE NOT been found responsible for violating a high school, college or university policy or been subject to discipline through a Title IX or sexual misconduct proceeding or criminally convicted for sexual violence, interpersonal violence or any other act of violence as described above, AND that I did not leave any prior institution with conduct charges PENDING for such acts.

I attest that I HAVE been found responsible for violating a high school, college or university policy; or been subject to discipline through a Title IX or sexual misconduct proceeding; or criminally convicted for sexual violence, interpersonal violence or any other act of violence as described above OR HAVE PENDING charges through a Title IX or sexual misconduct proceeding.

Was the Title IX or sexual misconduct proceeding complete or pending at the time of your transfer to Drew University?

Complete

Pending

Institution Name:

Date of Violation

I agree to allow the Drew Athletics Compliance Officer through oversight of the Title IX Office and with assistance of the Athletic Department where applicable, to contact the above institution to gather additional information regarding this disclosure.

By signing below, I attest that, to the best of my knowledge and belief, that all information attested to on this form is accurate and complete, and that providing purposefully false information on this form could result in penalties by the university and the NCAA, including jeopardizing my eligibility and/or scholarship receipt.

The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name, this will count as your electronic signature.

Name

Sport

Signature

Today's Date

Drew ID#

Athletic Status (select one):

First-Year

Transfer

Returning