Prospective Student-Athletes:
Thank you for your interest in becoming a member of an intercollegiate athletic team here at Medgar Evers College – CUNY.
Please note that in order to participate in ANY team-related activity (try-out, practice, scrimmage, game, etc.) you must first submit a completed Pre-Participation Medical Packet. Packets are available (through the athletic training room C-222) only to those prospective student-athletes who have been initially declared
Academically Eligible by the Director of Compliance/Athletic Coordinator Videl Price (office: CP-21, Carroll Street Building, 718-270-6494,
vprice@mec.cuny.edu).
Please refer to
this document to see what the requirements for academic eligibility are for Medgar Evers College Athletics. Please contact Mr. Price, as well as Academic Counselor Michell Cadet (
micadet@mec.cuny.edu) to find out if you are academically eligible, or exactly what you need to do in order to become academically eligible.
The Pre-Participation Medical Packet includes the following:
- Intercollegiate Athletics Medical History Questionnaire
- All questions must be completed
- Intercollegiate Athletics Pre-Participation Physical Exam Form
- Must Be Completed – Signed, Stamped, Dated – by an MD (Doctor of Medicine)
or a DO (Doctor of Osteopathic Medicine) ONLY
- Forms signed by a PA (Physician’s Assistant), DC (Doctor of Chiropractic), NP (Nurse Practitioner) will NOT be accepted
- Form must be completed/signed by MD/DO no more than 6 Months before your expected date of participation
- Student-Athlete Emergency Contact & Health Insurance Information Form
- If you have a personal Health Insurance Policy you must complete the form listing all pertinent information
- Attach a copy – both front and back – of all relevant valid insurance cards
- Complete the section located at the bottom of the form Denial of Insurance Coverage ONLY if you DO NOT carry a personal Health Insurance Policy
- Student-Athlete Assumption of Risk Form
- Student-Athlete Authorization, Agreement and Consent to Treatment Form
- Student-Athlete Authorization/Consent for Disclosure of Protected Health Information (PHI) Form
- Concussion Information Form – Retain the NCAA Concussion Fact Sheet for your records
- Sickle Cell Trait Information, Testing Declaration & Waiver – Retain the NCAA Sickle Cell Trait Fact Sheet for your records
- You will be required to watch the NCAA’s Sickle Cell Trait and the student-athlete video
- For Student-Athletes diagnosed with ADD/ADHD only: Student-Athletes on medications for ADD/ADHD must submit the NCAA Reporting Form for ADD/ADHD Medications (one page, plus documentation). The student-athlete’s physician must complete the NCAA reporting form and include supporting documentation. This form can be obtained from the Athletic Department and/or Athletic Training Room if needed. This form needs to completed/submitted only once, unless the prescribed medication changes.
If you have any questions, please contact:
John Nostro MS, ATC, CSCS
Head Athletic Trainer/Strength and Conditioning Coach
Medgar Evers College
1150 Carroll Street, Room C-226
718-270-6468 office
jnostro@mec.cuny.edu
