| REQUEST FOR AN APPEAL OF THE ELIGIBILITY REVIEW OF A STUDENT-ATHLETE |
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This form and all supporting information should be mailed to
This form and all supporting information should be mailed to:
PSAL
44-36 Vernon Boulevard, 4th Floor,
Long Island City, NY 11101.
Attention: Arnold H. Nager, Hearing Officer
(PSAL
ELIGIBILITY FORM B)
| Submitted By |
________________________ |
_________________________ |
_________________________ |
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Name |
Title |
Date |
| Name Of Student |
__________________________________________________________________ |
| Osis Number |
__________________________________________________________________ |
| Sport |
__________________________________________________________________ |
| School |
__________________________________________________________________ |
| Athletic Director |
__________________________________________________________________ |
| Principal |
__________________________________________________________________ |
| Coach |
__________________________________________________________________ |
| Contact Info (phone/e-mail) |
__________________________________________________________________ |
Please provide a brief description of the nature of the review. Attach any pertinent documentation.
| Principal's Signature |
_________________________________________ |
| Coach's Signature |
_________________________________________ |
| Athletic Director's Signature |
_________________________________________ |
| Parent's Signature |
_________________________________________ |
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