L:\Regulations, Procedures & Guidelines\NTRP Procedures\NTRP Self-Rate Appeal Form Word Format2006.doc Page 1 of 5

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NTRP Self-Rate Appeal Form [this will be a blank form]

*Indicates a required field.

NAME:
(Provide Maiden name or other spellings if appropriate)
ADDRESS*:
CITY*:
STATE*:
ZIP*:
GENDER:
Date of Birth:
/ USTA Member #
League Team #
HOME PHONE*:
WORK PHONE:
EMAIL*:
FAX:
GENERAL INFORMATION
Please read the NTRP General Characteristics & the Experienced Player Guidelines. / How long have you played tennis? total years
SELF-RATE REQUESTED:
Minimum Self-rate assigned: / Do you play in other competitive leagues/club programs? What Level?
Name of League(s):
1.
2.
3.
LIST SPORT AFFILIATIONS (example - USPTA)
Have you ever worked as the following professional?
Affiliation / How Long
Years
Years
Years
/ Most Recent Dates
College Coach
Teaching Professional
TENNIS EXPERIENCE
JUNIOR HISTORY / WHERE / YEAR(s) / ITF/National/Section/State / Highest Position and/or Ranking
High School Tennis Team
ITF/National/Section Junior Rankings
ITF/National/Section Junior Rankings
ITF/National/Section Junior Rankings
COLLEGE HISTORY / WHERE / YEAR(s) / ITF/National/Section/State / Highest Position and/or Ranking
College Tennis Team
Division:
College Tennis Team
Division:
College Tennis Team
Division:
PROFESSIONAL HISTORY / WHERE / YEAR(s) / ITF/National/Section/State / Highest Position and/or Ranking
Special Recognitions/Rankings / Achievements during High School or College career:
1. / Year: Title:
2. / Year: Title:
3. / Year: Title:
Other Organized Competitive Sports (Example: Volleyball, Lacrosse, Baseball, sport you lettered in)
1. / Other Sport Name: Level: Year(s):
2. / Other Sport Name: Level: Year(s):
3. / Other Sport Name: Level: Year(s):
USA LEAGUE INFORMATION
Played in USA League:
List most recent year you played USA League
USA League Year / USA League Section / USA League Division / NTRP Level / Local or highest Championship reached
USTA TOURNAMENT INFORMATION
List most recent year you played in NTRP, Age or Open tournaments:
Divisions you have played: / USTA Tournament NTRP levels:
/ USTA Tournament Age/Open
Ranking # Held / Year / NTRP, Age or Open / Singles or Doubles / Section or National
OTHER CONSIDERATIONS
Do you have any special physical or medical conditions that would affect your level of play?
Describe: (be brief and specific -- date of injury, diagnosis, treatment, prognosis and name of attending physician)
Are you currently being treated for an injury that would affect your tennis?
Provide specifics:
List any other information that may impact your tennis history or rating level
APPEAL TRUTH STATEMENT
I state the information presented is correct. If it is found that I have falsified or omitted any pertinent information, it may result in disqualification from USA League Tennis play.
Submitted by:
Name:

Bottom of Form

These supplementary instructions provide information necessary to complete the appeal form:
Player Contact Info

  • NAME, USTA Member# and League Team # are pre-populated on the form and cannot be entered or changed.
  • Address, City, State, Zip, Home Phone and Email are required
  • Work Phone and Fax are optional
  • Phone numbers must be entered in (555)555-1234 format

General Information

  • Minimum Self-rate assigned is pre-populated on the appeal form and cannot be changed
  • Self-Rate requested (required)– Select the rating value for your appeal from 2.0, 2.5, 3.0,…… to 7.0
  • The following fields may be marked N/A if they do Not Apply
  • How long have you played tennis? – total years
  • Played in Competitive Leagues
  • If answer is Yes, Level played in League is required to be entered
  • Name of League(s) – up to 3 can be entered

Sport Affiliations (mark N/A if they do not apply)

  • Affiliation and How long affiliated (years) – Up to 3 affiliations can be entered (e.g., USPTA)
  • Worked as College Coach – Most recent dates
  • Worked as Teaching Processional – Most recent dates

TENNIS EXPERIENCE
Junior History (mark N/A if they do not apply)

  • High School Tennis Team – where, Year(s) played, ITF/National/Section/State and Highest Position or Ranking
  • ITF/National/Section Junior rankings - where, Year(s) played, ITF/National/Section/State and Highest Position or Ranking
  • Other Junior History – up to 2 entries are available

College History (mark N/A if they do not apply)

  • College Tennis Team - where, Year(s) played, ITF/National/Section/State and Highest Position or Ranking, Division
  • Select from Division values I, II, III, NAIA and Junior College
  • Up to 3 College Rankings can be entered

Professional History (mark N/A if they do not apply)

  • Select: Foreign, Satellite, Davis Cup, Fed Cup, Pro Circuit or teaching professional from dropdown list
  • Enter where, Year(s)played, ITF/National/Section/State and Highest Position or Ranking, Division
  • Up to 3 Professional Histories can be entered

Special Sport Recognition/Rankings Achievements (mark N/A if they do not apply)

  • Enter Year and Title for up to 3 recognitions/rankings/achievements during high school and college

Other Organized Competitive Sports that you lettered in (mark N/A if they donot apply)

  • Enter Sport Name, select Level (High School or College), and enter Year
  • Up to 3 Other Organized Competitive Sports can be entered

USA League Information (mark N/A if they do not apply)

  • Indicate whether you played in USA League
  • Enter most recent year played in League
  • Enter information on the 3 most recent years of USA League play:
  • Year
  • Select Section from list
  • Select USA League Division from list: (Adult, Senior, Mixed Doubles, Super Seniors, Mixed Seniors, Combo, Other)
  • Select NTRP level from List: (Open, 2.5, 3.0, 3.5, ……..10.0)
  • Select Local or Highest Championship reached from list: (Local, Local Playoff, Area/District, State, regional, National)

USTA Tournament Information (mark N/A if they do not apply)

  • Enter most recent year played in USTA tournament
  • Select divisions ever played in USTA Tournament
  • NTRP Levels – (2.5, 3.0. 3.5, …….10.0)
  • Age Open – (Open, 16, 18, 25, 30, 35, 40, ……90)
  • Multiple divisions can be selected for NTRP Levels and Age/Open
  • Enter up to 3 ranking numbers held, year, select division from list (includes NTRP and Age Open values), indicate Singles or Doubles, and Section or National

Other Considerations (mark N/A if they do not apply)

  • Describe special conditions, treatment or other information that may affect level of play

Appeal Truth Statement (required)

  • Check box to indicate that information submitted for appeal is correct
  • Indicate whether appeal is submitted by Player or Captain/Administrator
  • Enter name of person submitting appeal form