Drug Testing Agreement Form

The Department of Intercollegiate Athletics at Southeastern Community College believes that policies governing student athletes should be designed with the understanding that such individuals have special needs and responsibilities. Those policies and related programs should reflect the concern for the college, its students and personnel. With this in mind, a comprehensive drug-screening program for our athletes is necessary to maintain a wholesome atmosphere in which to successfully participate in the classroom and in the athletic arena. The NJCAA in accordance with the NCAA Drug Testing Policy, encourages member institutions to conduct drug testing for the purpose of the well being of the student-athlete. Removing the student-athlete from competition is not the primary objective of our policy. Rather, it is to counsel, educate, and help those student-athletes who may test positive. 

I, the undersigned student athlete, hereby acknowledge that I have received a copy of the Southeastern Community College (SCC) Department of Intercollegiate Athletics Substance Abuse Policy. I further acknowledge that I have read said Policy, and that I fully understand its provisions.

I hereby consent to have a sample of my urine collected and screened for the presence of non-prescribed or prohibited drugs or substances on a random or unannounced basis in accordance with the provisions of the SCC Intercollegiate Athletic Department Substance Abuse Policy; and at such other times as urinalysis screening is required under said Policy.

I understand that this screen and analysis will be conducted by qualified laboratory personnel from an approved laboratory agency selected by the Athletic Director. I also understand that a documented chain of specimen custody exists to ensure the identity and integrity of my sample throughout the collection and testing process. 

I further understand that my results will be reported to and remain in exclusive confidential possession of the SCC Athletic Department in accordance with the Drug Screening Program and Policies.

I further authorize the confidential release to the SCC Athletic Department, of all test results and other information or records obtained or created in the course of screening or testing any of my urine samples under the provisions of the SCC Athletic Department Drug Screening Program and Policies. To the extent set forth herein, I waive any privilege I may have in connection with such information.

Due to the provisions outlined, I consent to this request for the urine specimen. I hereby and here with release the SCC Athletic Department, SCC Board of Trustees, the Team Physician, the approved laboratory agency, and all employees and agents of these institutions from any and all liability arising from the request to furnish this urine sample, the testing of the urine sample, and decisions made based on the results of the analysis.

Additional Conditions of Participation and Financial Aid Agreement

I understand that SCC has a drug screening program for the purpose of education, prevention, detection, and deterrence of substance usage and abuse. In accepting the privilege to participate in intercollegiate athletics, I agree to drug screening and drug testing and I understand that non-compliance with the college substance abuse policy will be a breach of the privilege to participate, which will result in removal from the team and loss of my athletic-related financial aid. I agree that I do not have a vested property right in any athletic-related financial aid or scholarship and the same can be forfeited by violation of the substance abuse policy by me.

The Family Educational Rights and Privacy Act (FERPA) require Southeastern Community College to release non-directory information only to the student. The student may, however, voluntarily waive the privacy rights and authorize certain individuals to receive the non-directory information. By signing this form, the student waives these rights and allows the following information, when necessary, to be provided to schools for recruitment purposes or to which you are transferring and to media, the Iowa Community College Athletic Conference (ICCAC) and the National Junior College Athletic Association (NJCAA) as well as any other affiliated organization related to NJCAA athletics: ? Physical/Medical Records ? Grades/Unofficial Transcripts ? Tracers/Transfer Waivers ? Student Academic Progress/Reports ? Financial Records including the Student Air Report (SAR or ISIR) ? Game Film ? Athletic Performance/Stats ? Photos/Media Release ? Release Information ? I further grant permission for either of the two named individuals to release an Unofficial Copy (student copy) of my SCC transcript to any college Athletic Department. I authorize Southeastern Community College Athletic Department, Coaches, and/or Training Staff to disclose some or all of the above information to other schools wanting to recruit me.

Release Form Confirmation for Student-Athlete

I am submitting this form as a Student-Athlete and by clicking the below checkbox and confirming that I have read, understand, and voluntarily sign this release form.

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