Agent Registration Renewal Form
Any agent, as defined by the California Miller-Ayala Athlete Agents Act and the NCAA, must be registered with the Stanford
University Compliance Services office prior to having communication with Stanford student-athletes. If you have not previously
registered with the Stanford Compliance Services office, please complete the Stanford Athlete Agent Registration form and
return it to the address listed below. If you have previously registered with the Stanford Compliance Services office, you are
required to submit this form, as well as any updated documentation, on an annual basis.
By signing this form, I certify that I have reviewed the NCAA rules and regulations pertaining to agents and that I have not and
will not engage in any activitiy that would otherwise jeopardize a student-athlete’s eligibility prior to a student-athlete’s
agreement to be represented. Further, I certify that I will notify the Stanford Compliance Services office before the first contact
with a student-athlete (any individual who is enrolled at Stanford University and who has eligibility remaining in any sport) or a
student-athlete’s coach. I also understand that failure to comply with the terms of this certification and the applicable state of
California laws and NCAA legislation may result in the initiation of legal proceedings by Stanford University against me.
Contact Information
_______________________________________
________________________________________________________
Name
Name of Firm/Agency
_______________________________________
________________________________________________________
Phone
Email
________________________________________________________________________________________________________
Business Address
Registration Information
______________________________________________________
____________________________________
Expiration Date of Players Association Certification (if applicable)
California Agent Registration Number
Please list the name and sport(s) of any current Stanford University student-athlete(s) you plan to contact in the upcoming year:
_______________________________________________
Name
Sport
_______________________________________________
Name
Sport
_______________________________________________
Name
Sport
________________________________________________
Name
Sport
________________________________________________
Name
Sport
________________________________________________
Name
Sport
Please list any changes that to the current registration on file (e.g., firm/agency, status of a current players association or state of
California certification, disciplinary action):
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_______________________________________________
Signature
________________________________________________
Date
Return Completed Form To:
Department of Athletics
Stanford University
c/o Heidi Vinovich
Arrillaga Family Sports Center
641 East Campus Drive
Stanford, CA 94305
[email protected]
Phone: 650.723.1038
Fax: 650.725.8642