If an organization would like to request the attendance of the Georgia Tech Athletic Association at an outreach program, please fill out the following questionnaire. In order to process the promotional activity waiver request in a timely manner and not jeopardize a student-athlete’s eligibility status, Georgia Tech reserves the right to deny any and all requests not submitted a month prior to the activity date. All requests will not be accepted until it clears all NCAA regulation, including NCAA Bylaws 12.5.51 and 12.5.1.2.

First Name

Last Name

Email Address

Phone

Name of agency/organization represented:

Location of event including address:

Date of event:

Start time of event:

End time of event:

Which sport(s)/student-athletes are you requesting: (Please include desired number of athletes)

Briefly describe the event:

Duties of the student-athlete at the event:

Primary target audience of the event:

If the event takes place during a meal time, will food be provided?

Verify characters: