PARENTS-COACHES ASSOCIATION

SCHOLARSHIP POLICY EXCEPTION

The use of PCA scholarship funds could jeopardize your ability to compete in college level varsity sports. In order for PCA to remit payment of scholarship funds as outlined in our Scholarship Policy, you must sign the declaration found at the bottom of this form and return it to:

PCA

ATTN: Scholarships

PO BOX 224

ODENTON, MD 21113

If a signed declaration form is not on file, the PCA will not be able to disburse your funds.

You need to be fully aware of the impact that submitting this declaration may have on your eligibility to play college level varsity sports. Upon granting of this exception and accepting reimbursement of expenses, the net result is that you may be ruled ineligible to compete in college level varsity sports. Please take the time to consider the implications this may have if you were to decide later to participate in college level varsity sports before signing this declaration. Again, please take note that no funds will be disbursed without the signed declaration on file.

DECLARATION

By signing this declaration, I ___________________________ acknowledge that my actions may result in my being declared ineligible for college varsity level competition.

I further acknowledge that I have read and understand the PCA Scholarship Policy and the PCA Exception Policy and agree to be bound by the terms and conditions.

_____________________________________ _____________________

Signature Date

_____________________________________ _____________________

Printed Name Day Telephone Number