Tennessee Tech NIL Activity Pre-Approval Form

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For: Student-Athletes who will be or have been compensated for the use of their names, images, and likenesses for promotional purposes.

Action: Complete the form in its entirety and sign and return to Amanda Thatcher, Assistant AD for Compliance. This information will be kept on file in a manner consistent with federal and state law, if applicable.

Due Date: Prior to participation in NLI activities. Failure to disclose may impact the student-athletes' eligibility.

Please list start date of activity and the end date of the activity
Please list the number of activities, initial start date of activities and estimated end date of activities
If there is start or no end date to the activity, please explain (i.e. posting monthly for the next year ? provide first posting date and/or all anticipated dates the student ? athlete will be posting):
How will you be compensated for your Name, Image and Likeness Activity(s)? *
Method of Payment (Check all that apply):

Complete one of the following payment choices:

Explain (i.e. Athlete kept all clothing used during photoshoot, received merchandise or discount)
How will you travel to the Name, Image and Likeness Activity, if applicable? *
What is your schedule? *
Anticipated days of the week the student-athlete will be involved in activities (check each day you will be or likely will be taking part in activities)
Please list the name of each person/entity, their role and their contact information (including cell and/or email)

By submitting this form, I acknowledge that my institution, or a designee of my institution, may review the accuracy of this information, and I consent to any investigation, review, or audit. I acknowledge that inaccurate or incomplete disclosure or failure to cooperate could support a reasonable conclusion that compensation I received constituted an inducement to attend or remain enrolled at a specific school, a substitute for pay for athletics performance or participation, or an otherwise illegitimate source of compensation for use of my name, image, and likeness.

* required field