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The form is due by Jan 31st or your first game of the term.

Mail Completed Forms to:ACHA ComplianceAttn ic! "amins!i

#$$%& MoranHarrison T'p( M) *+,*-

The team section must be T/0 to be accepted. This includesthe 2 of semesters played.

o pre4printed school forms 'ill be accepted.The ACHA form must be completed.

Prior Term Credits Passed5 Credits passed during the periodof 6ep #,1- 4 ec #,1- 789.Current Term Credits Enrolled5 Total credits enrolled 7as oftoday from Jan #,1& thru Aug #,1&.

7/24/2019 acha_wint_elig_d3_2

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American Collegiate Hockey AssociationDivision 3 - Winter Eligibility Form

Due by Jan 3st or st !ame

Mail Completed Forms to:ACHA ComplianceAttn ic! "amins!i

#$$%& MoranHarrison T'p( M) *+,*-

Please do not send "orms overnite #it$ a re%uired signature& T$is #ill cause a DE'A( in receiving your "orms&

6chool ame:

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Completed by Team Representative (Typed Only)The belo' listed student athletes( by their signature( consent to

the release of grades( academic standing( and recordsinformation to the ACHA 7American Collegiate Hoc!ey

Association for the purpose of de termining their athletic eligibilityfor the current #,134#,1* hoc!ey season.

Player )ignature

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7/24/2019 acha_wint_elig_d3_2

3/3

American Collegiate Hockey AssociationDivision 3 - Winter Eligibility Form

Due by Jan 3st or st !ame

Mail Completed Forms to:ACHA ComplianceAttn ic! "amins!i

#$$%& MoranHarrison T'p( M) *+,*-

Please do not send "orms overnite #it$ a re%uired signature& T$is #ill cause a DE'A( in receiving your "orms&

6chool ame:

egistrar ame: 6igned:

Team ep. ame: Completed by:Affi; 6chool 6eal here.

Contact /hone 2: /hone umber:

0mail Address: 0mail Address: ate: ( #,1&

Completed by Registrar

9ast ame First ame 6tudent ) 2

Completed by Team Representative (Typed Only

)The belo' listed student athletes( by their signature( consent to

the release of grades( academic standing( and recordsinformation to the ACHA 7American Collegiate Hoc!ey

Association for the purpose of determining their athletic eligibilityfor the current #,134#,1* hoc!ey season.

Player )ignature

.2of6em.

/layed7,41,:

/riorTerm

Credits/assed

CurrentTerm

Credits

0nrolled

8 68 >J > 6 >

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