EmailMeForm
Medical Waiver Appeal
Please complete the form below and provide all supporting documentation for review.
School Classiification
Please select
1A
2A
3A
4A
5A
6A
School Name (City / School)
School Contact
First
Last
Email for School Contact
Phone Number for School Contact
###
-
###
-
####
Student Information
Student Name
First
Last
Student Grade Level
Please select
9th
10th
11th
12th
Activity for which appeal is being made
Governance Rule Being Appealed
ie (NFHS Basketball Rule 12.3.a.ii)
Medical Condition
Supporting Documentation
Total
$25.00
