Application for Continuing Full Membership Effective with 2013-14 ...

General Information
Full legal name of school:
Florida High School Athletic Association
MB2
Revised 03/13
Application for Continuing Full Membership Effective with
2013-14 School Year (page 1 of 4)
Instructions:
1. A fully completed application packet must be returned by fax (352) 244-5050, e-mail (application@fhsaa.org) or by mail to Membership Services
Specialist, FHSAA, 1801 NW 80th Blvd, Gainesville, FL 32606-9176, so that it is received in the FHSAA Office not later than Tuesday, April 30, 2013, to
avoid a late fee. Application packets received after Friday, May 31, 2013 may not be considered for continuing membership in the 2013-14 school year.
2. A fully completed application packet consists of this application form (all four pages) completed in its entirety and bearing all necessary signatures, as well
as all required documentation.
3. Application must be typed. Hand written applications will not be accepted. This application form (MB2) is available for download on the Membership
Services and General Forms pages of FHSAA.org as a PDF document that can be typed on screen and printed out. The addresses are http://http://www.fhsaa.
org/departments/membership and http://www.fhsaa.org/forms/general.
County in which school is located Lowest grade in school Highest grade in school
Mailing address (street, PO Box, route, etc.) City Zip code
Physical address (street, PO Box, route, etc.) City Zip code
Type of school (check only one):
Senior high school (provides instruction at one or more grade levels 9-12)
Middle/junior high school (provides instruction in middle school grades 6-8 or junior high school 7-9)
Combination school (provides instruction at both middle/junior high school & senior high school grade levels)
This combination school offers ONLY high school-level sports teams
This combination school offers BOTH middle- and high school-level sports teams
Home education cooperative (parent-directed group of individual home-educated students)
Category of school (check only one):
Traditional public school
Charter school
Private school (day school only)
Private school (with boarding program)
University laboratory school
Virtual School
Mandatory Senior High School/Combination School Accreditation
A member senior high school/combination school MUST BE ACCREDITED by one or more of 15 different accrediting agencies approved by the Association. Middle schools/
junior high schools and home education cooperatives are exempt from this requirement. A continuing member senior high school/combination school that loses its accreditation
at any time will have a maximum of three years to regain accreditation. No membership privileges are withheld during the three-year period. If accreditation is not regained
after that three-year period, all athletic programs within the school will be suspended until re-accredited. The 15 approved agencies are listed below. Provide the year of accreditation,
the year of the school’s last review/evaluation, and the year of the school’s next scheduled review/evaluation beside each agency that has accredited this school.
Year Year of Last Year of Next
Year Year of Last Year of Next
Approved Accrediting Agency Accredited QAR/Eval QAR/Eval Approved Accrediting Agency Accredited QAR/Eval QAR/Eval
Association. of Christian
Florida Coalition of Christian
Schools International
Private School Associations
Association of Christian
Florida Conference of Seventh-
Teachers and Schools
Day Adventist Schools
Association of Independent
Florida Council of Independent
Schools of Florida
Schools
Christian Schools of Florida Fla. League of Christian Schools
Council of Bilingual Schools Lutheran Schools of FL-GA
Episcopal Diocese of Florida National Independent Private
School Association
Florida Association of Christian
Colleges and Schools
Florida Catholic Conference
SACS/CASI
-- If the school is not accredited by one of the 15 approved agencies listed above, answer the following questions: --
Is the school accredited by any agency other than one of the 15 listed above? Yes No If yes, provide name of agency. If no, state reason for not being accredited.

Application for Continuing Full Membership Effective with 2013-14 School Year Page 2 of 4
2013-14 Principal (provide name and contact information for the person who will be Principal in the 2013-14 school year)
Name of person who will be principal in 2013-14 school year
Dr. Mr. Mrs. Ms. Rev.
Title of principal (check one)
Principal Headmaster Director Other:
Principal’s office phone number Principal’s office fax number
( ) ext. ( )
Principal’s home phone number (not for publication) MANDATORY Principal’s cell phone number (not for publication) MANDATORY
( ) ( )
Principal’s office e-mail address Name of Principal’s assistant
Assistant’s office phone number Assistant’s office e-mail address
( ) ext.
Is this individual currently the principal at this school?
Yes No
If no, provide the name of the current Principal:
Dr. Mr.
If no, provide date new Principal is set to assume duties: If no, provide e-mail address of new Principal:
Designation of FHSAA Representative
The principal MUST designate the administrator who will act as the school’s official representative to the FHSAA for the 2013-14 school year. This individual will be
the school’s primary point of contact regarding FHSAA matters; will be the addressee on all FHSAA-provided material and information; will be the only individual
in the school who is eligible for election to offices in the FHSAA governance structure; will be the only individual in the school who is eligible to vote in FHSAA
governance elections; and, other than the principal, will be the only person authorized to sign FHSAA-required documents. Once designated, the FHSAA Representative
cannot be changed except in writing by the principal. [NOTE: Designation of an individual other than the principal will in no way relieve the principal of ultimate
responsibility for the conduct of the athletic program at the school. (Bylaw 6.1.2)]
Name of person who will be FHSAA Representative in 2013-14 school year
Dr. Mr. Mrs. Ms. Rev.
Administrative position of FHSAA Representative (check one)
Principal Assistant Principal Athletic Director {Must be one of three listed - s. 1006.20 (3)(b) F.S.}
FHSAA Representative’s office phone number FHSAA Representative’s office fax number
( ) ext. ( )
FHSAA Representative’s home phone number (not for publication) MANDATORY FHSAA Representative’s cell phone number (not for publication) MANDATORY
( ) ( )
FHSAA Representative’s office e-mail address
Mrs. Ms.
2013-14 Athletic Director (provide name and contact information for the person who will be Athletic Director in the 2013-14 school year)
Name of person who will be Athletic Director in 2013-14 school year
Dr. Mr. Mrs. Ms. Rev.
Athletic Director’s office phone number Athletic Director’s office fax number
( ) ext. ( )
Athletic Director’s home phone number (not for publication) MANDATORY Athletic Director’s cell phone number (not for publication) MANDATORY
( ) ( )
Athletic Director’s office e-mail address Name of Athletic Director’s assistant
Assistant’s office phone number Assistant’s office e-mail address
( ) ext.
Is this individual currently the AD at this school?
If no, provide the name of the current Athletic Director:
Yes No Dr. Mr.
Mrs. Ms.
If no, provide date new Athletic Director is set to assume duties: If no, provide e-mail address of new Athletic Director:
_____________________________________________________________________________ ___________________________________________
Signature of Principal (REQUIRED) Date

Application for Continuing Full Membership Effective with 2013-14 School Year Page 3 of 4
Private School Applicants Must Complete This Section
Name of owner(s) of this school Ownership (check all that are applicable):
Proprietorship Corporation for Profit Not-for-Profit (501-C-3) Corporation
Mailing address of owner(s) (street, PO Box, route, etc.) City Zip Code Years under current ownership
FHSAA Bylaws and Florida Law permit home-educated students to participate in interscholastic activities at a private school that accepts them for such participation.
Does this private school accept home-educated students for participation in its interscholastic athletic programs? Yes No
Is school government-approved to issue I-20 forms for foreign student admission? Does school offer financial assistance programs of any kind to students?
Yes No Yes No
Does school or anyone associated with school provide any assistance to non-boarding students in obtaining housing in the community? Yes No If yes, please explain
Charter School/University Laboratory School Applicants Must Complete This Section
Name of owner(s)/operator(s) of this school Ownership (check all that are applicable):
Proprietorship Corporation for Profit Not-for-Profit (501-C-3) Corporation
Mailing address of owner(s)/operator(s) (street, PO Box, route, etc.) City Zip Code Years under current ownership
Name of school district board or state university sponsoring this program Date charter approved Term of charter Date charter expires
Is school government-approved to issue I-20 forms for foreign student admission? Does school offer financial assistance programs of any kind to students?
Yes No Yes No
Does school or anyone associated with school provide any assistance to non-boarding students in obtaining housing in the community? Yes No If yes, please explain
Boarding School Applicants Must Complete This Section
Total number of boarding students in grades 9-12 Is boarding program verified by FCIS and/or SACS?
Yes No
Does school own or lease dormitory facilities? Are dormitory facilities on campus?
Own Lease
Yes No If no, where are dormitory facilities located?
Schools Offering Any Form of Financial Assistance Must Complete This Section
Is financial assistance offered by this school based strictly on objective need? Yes No If no, on what other criteria may financial assistance be based?
Check below the FHSAA-recognized independent organization used by this school to evaluate a student’s need for financial assistance:
Auncor Inc. (Tuition Aid Data Services) Financial Aid Independent Review School and Student Service for Financial Aid
FACTS Management Company Financial Aid for School Tuition (Independent School Management)
Family Financial Needs Assessment Private School Aid Service Smart Tuition
Does this school offer work-study programs?
Yes No If yes, briefly describe these programs (including how hours work translate into funds credited):
Are coaches or other athletic personnel permitted to supervise student-athletes in work-study programs?
Yes No
Are student-athletes permitted to participate in work-study programs during the period of time when the sports they play are in season?
Yes No

Application for Continuing Full Membership Effective with 2013-14 School Year Page 4 of 4
Presence of AED at State Series Contest(s)
It is strongly recommended that an automated external defibrillator (AED) be present and available for use if needed at the site of every preseason and
regular-season interscholastic contest in which member high schools/combination schools participate. The presence and availability of an automated
external defibrillator (AED) shall be mandatory at the site of every FHSAA State Championship Series contest on the district, regional and state levels.
You must select one of the choices below. By checking the box that there is no AED available IN NO WAY WILL PENALIZE THE SCHOOL
FINANCIALLY OR OTHERWISE. It simply means the school will not be able to host a postseason contest. (check only one)
This high school/combination school has/will have an AED available at home contests
(By checking this box, I certify that if chosen as an FHSAA State Series host at least one AED will be present at all contests.)
This high school/combination school does not/will not have an AED available at home contests
(By checking this box, I certify that this school will not be able to host any FHSAA State Series postseason contests.)
This middle school/junior high school has/will have an AED available at home contests
This middle school/junior high school does not/will not have an AED available at home contests
Certification of Principal
Please accept this school’s application for continuing membership in the Florida High School Athletic Association effective with the 2013-14
school year. By my signature below I certify the following:
1. I have reviewed the information provided on this form and have found it to be complete and accurate to the best of my knowledge. I understand that this application
will not receive consideration unless all required documentation is included.
2. I fully understand the obligations of membership in the FHSAA. These obligations include:
(a) The obligation that the school controls its interscholastic athletic programs in accordance with the rules of the Association, and that the responsibility for this
rests with me as principal of the school;
(b) The obligation that the school complies with all rules of the Association, monitors its programs to assure compliance, and reports to the FHSAA Office when
compliance has not been achieved and take appropriate corrective actions;
(c) The obligation that the school certifies the eligibility of all student-athletes, and does not permit a student-athlete to participate in competition unless the
student-athlete meets all eligibility requirements;
(d) The obligation that the school fully cooperates with the FHSAA in the investigation of any alleged violation, as well as in any audit of the school to verify
compliance with the rules of the Association;
(e) The obligation that the school be represented at an FHSAA compliance seminar as outlined in Policy;
(f) The obligation that the school provides the necessary insurance coverages for itself and its student-athletes with at least the required minimums established
by the FHSAA Board of Directors;
(g) The obligation that the school establishes policies that promote sportsmanship and ethical conduct in its interscholastic athletic programs; and
(h) The obligation that the school accepts in good faith the decisions of the Association.
3. I understand, that if chosen to host a postseason interscholastic event, the facility my school uses as the host site meets or exceeds the minimums set forth by
Policy.
4. I understand that this school may be elected to continuing membership effective with the 2013-14 school year only by a majority vote of the FHSAA Board of
Directors at its annual year-end meeting.
_____________________________________________________________________________ ___________________________________________
Signature of Principal (REQUIRED) Date