Transfer Tracer Form- NCAA Division III

Athletics
SUNY Brockport

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Page 1 of 5 - Student-Athlete Information

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Part 1: Student-Athlete Information
Student-Athlete Name Student-Athlete Name First Last
About this form

The student-athlete identified in this form is looking to transfer or has transferred to SUNY Brockport. We are requesting some additional information from you in order to determine if he/she will be eligible to participate in our athletics program (NCAA DIII).
Sport(s):
Name of Institution
Type of Institution:

Type of Institution: NCAA Division I NCAA Division II NCAA Division III NAIA Two-year Other Other
Permission to contact the above named student-athlete is granted.

Permission to contact the above named student-athlete is granted. Yes No
If the student-athlete is currently enrolled in your institution and has not submitted a self-release form, may we have permission to speak with this student? (NCAA DIII institutions only)

If the student-athlete is currently enrolled in your institution and has not submitted a self-release form, may we have permission to speak with this student? (NCAA DIII institutions only) Yes No N/A
Dates student attended your institution:
From From / MM / DD YYYY
To To / MM / DD YYYY
Matriculation Status:

Matriculation Status: Full-time student Part-time student
Did the student-athlete earn a degree at your institution.

Did the student-athlete earn a degree at your institution. Yes No
List the Full-time semesters/quarter(s) student attended your institution (i.e. Fall 2019).
List semesters(s)/quarter(s) student attending your institution part-time.
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Enter Your Email Address *

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Transfer Tracer Form- NCAA Division III

Page 1 of 5 - Student-Athlete Information

Part 1: Student-Athlete Information

About this form

Dates student attended your institution: