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

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Principal’s home phone number (not for publication) MANDATORY Principal’s cell phone number (not for publication) MANDATORY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FHSAA Representative’s home phone number (not for publication) MANDATORY FHSAA Representative’s cell phone number (not for publication) MANDATORY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