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University Of Michigan Department Of Athletics 2010-11 University Of Michigan Agent Questionnaire Form. This is a Michigan form and can be use in Athletic Agent Registration Statewide.
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UNIVERSITY OF MICHIGAN DEPARTMENT OF ATHLETICS
2010-11 University of Michigan Agent Questionnaire
Note: This Form Must Be Completed In Its Entirety (please print or type)
1.
General Information
Name: ______________________________________
Date:
_______________________________
Firm: ______________________________________
Daytime Phone: ______________________________
Address: ____________________________________
Evening Phone: ______________________________
____________________________________
______________________________
____________________________________
2.
Fax:
E-mail:
______________________________
Please list your educational background. Include dates attended and degrees conferred.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3.
Please list your employment history for the last ten (10) years. Attach additional sheets if necessary.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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4.
Occupational or Professional Licenses
Are you currently certified by the NFLPA? Yes ____ No ____
Permanent Provisional
(circle one)
Are you currently certified by the NBAPA? Yes ____ No ____
Permanent Provisional
(circle one)
Are you currently certified by the MLBPA? Yes ____ No ____
Permanent Provisional
(circle one)
Are you currently certified by the NHLPA? Yes ____ No ____
Permanent Provisional
(circle one)
Please list any other occupational or professional licenses or other similar credentials you have
obtained other than college or graduate school degrees, including the dates they were obtained.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
5.
How many years experience do you have representing client-athletes?
_____________________________________________________________________________________
6.
Please identify which of the following services you provide for client-athletes:
Contract Negotiation
____
Financial Planning
____
Hourly fee or percentage
____
Grievance Arbitration
____
Appearance/Endorsements
____
Legal Assistance
____
____
Tax Planning
____
Hourly fee or percentage
Estate Planning
____
Other services (please explain):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
7.
Do you offer a separate contract for each of the services identified above? (please explain)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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8.
Are your customary fees for the above services based on a percentage of the client’s salary that you
negotiate, total income of the client, an hourly fee, or some other arrangement? (please explain)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
9.
For the services you perform for client-athletes, list the names and addresses of individuals, firms, or
agencies which assist in providing these services. Use additional sheets if necessary.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
10.
Describe your fee structure. Are your fees negotiable?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
11.
Do you expect to be paid for your services “up front” or as the player is compensated?
_____________________________________________________________________________________
12.
Under what conditions may a client terminate a contract?
_____________________________________________________________________________________
_____________________________________________________________________________________
13.
What happens if your client is waived from a team?
_____________________________________________________________________________________
_____________________________________________________________________________________
14.
Do you limit the number of clients you will represent? If yes, please explain.
____________________________________________________________________________________
____________________________________________________________________________________
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15.
Do you have an agreement, understanding, or relationship of any kind with any individual, firm, or
organization pursuant to which such an individual, firm, or organization solicits or encourages
clients to use your services? If yes, please explain, including whether or not you provide any
compensation or other consideration to such an individual, firm, or organization.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
16.
How many clients have you represented during your employment as a player agent?
_____________________________________________________________________________________
17.
How many clients are you currently representing in your capacity as a player agent?
____________________________________________________________________________________
18.
Please provide the names and telephone numbers of five athletes that you previously or currently
represent that may be contacted by the University of Michigan Compliance Services Office or a
University of Michigan student-athlete.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
19.
Please list all University of Michigan student-athletes that you currently represent or previously
represented.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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20.
Please list which current University of Michigan student-athlete(s) you plan to contact.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
21.
Have you ever been disbarred, suspended, reprimanded, censured, or otherwise disciplined or
disqualified as an attorney, as a member of any other profession, or as a holder or any public
office? If yes, please describe each action, the dates of the occurrence, and the names and
addresses of the authority imposing the action in question.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I certify that the above information is true, accurate, and complete to the best of my knowledge. Further, I certify
that I will notify the Director of Athletics (or his designated representative) before the first contact with a studentathlete who had eligibility remaining in any sport and is enrolled at the University of Michigan. I also have
reviewed the NCAA rules and regulations that accompany this form and have not engaged in any activity that
would jeopardize the eligibility of any University of Michigan student-athlete. I understand that failure to comply
with the terms of this certification and the applicable NCAA legislation may result in the initiation of legal
proceedings by the University of Michigan against me and the assessment of civil and/or criminal penalties to me.
Signature: _____________________________________
Date: ____________________________
Please return completed form and a photograph of yourself to:
Elizabeth Heinrich
Agent Liaison
University of Michigan
1000 S. State Street
Ann Arbor, MI 48109
Office: (734) 647-1194
Fax: (734) 763-7342
American LegalNet, Inc.
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