Name of the Individual Or Organization Making the Request: ______

Donation Request

Form

Name of the individual or organization making the request: ___________________________________

Contact Individual: ____________________________

Address: ___________________________________ E-Mail Address:___________________

City, State, Zip: _______________________________ Phone Number: ___________________

What type of item(s) is/are being requested? (i.e., *tickets, promotional materials, memorabilia, etc.):

____________________________________________________________________________

* If tickets are being requested—Number of Tickets: ________ Sport: ___________ Date of Game: _____

*Please be advised that the deadline for all group ticket donation requests is one week before the game

What is the purpose of the request? Check the appropriate box:

[ ] Fundraiser [ ] Auction [ ] Giveaway [ ] Promotion [ ] Group Outing

Ages and Grades of individuals who shall benefit from this request: _____________________________

Date of event/activity: _______________________________

Please provide your 501-c3 tax identification number: ______________________________________

NCAA Bylaw 13.15 prohibits all University staff members from participating in the following:

- Donating memorabilia (e.g., jerseys, hats, T-shirts, autographed footballs or basketballs) to any

organization/ event/activity that involves/benefits prospect-aged individuals (9th – 12th *grade and

junior college students). (*7th grade for requests involving anything associated with men’s basketball)

- Participating in any event in which a donation will be provided to a high school, prep school or two-year

college.

- Providing any financial contributions to a high school athletics program by participating in a

fundraising event.

By signing below, you attest that you have read and understand the previously mentioned

NCAA rules regarding impermissible fundraising activities. Furthermore, you agree to follow

all guidelines set forth by NCAA rules.

____________________________ ______________________ __________

Printed Name of Requestor Signature Date

Please Return Completed Form To:

Justin Bell

Assistant Director, Compliance

Northeastern University Athletics

Fax# 617.373.8988

_____________________________________________________________________

For Athletic Department Use Only: [ ] Request is approved. [ ] Request is denied.

Signature of Compliance Office: _______________ Date: __________________________

Fulfillment Date: _________________________ Record Locator: ___________________