NTRP Self-Rate Appeal Form [this will be a blank form]

*Indicates a required field.
NAME:      GENDER:  
MAIDEN/OTHER NAME:
ADDRESS*:
CITY:
STATE*: ZIP*:
 
GENDER:
Date of Birth:
USTA Member #
League Team #
HOME PHONE*:
WORK PHONE:
EMAIL*:
FAX:
 
GENERAL INFORMATION
Please read the NTRP General Characteristics & the Experienced Player Guidelines. How long have you played tennis?*           total years
SELF-RATE REQUESTED:
Minimum Self-rate assigned:
Do you play in other competitive leagues/club programs? 
What Level:
Name of League(s):
1.
2.
3.
 
LIST SPORT AFFILIATIONS (example - USPTA)
Have you ever worked as the following professional?
Affiliation How Long
Years
Years
Years
  Most Recent Dates
College Coach

Teaching Professional

Explanation:
 
TENNIS EXPERIENCE
JUNIOR HISTORY WHERE YEAR(s) Type of Ranking Highest Position and/or Ranking
High School Tennis Team  State:           
ITF/National/Section Junior Rankings
ITF/National/Section Junior Rankings
ITF/National/Section Junior Rankings
Explanation:
COLLEGE HISTORY WHERE YEAR(s) Type of Ranking Highest Position and/or Ranking
College Tennis Team
  Division:
College Tennis Team
  Division:
College Tennis Team
  Division:
Explanation:
 
PROFESSIONAL HISTORY WHERE YEAR(s) Type of Ranking Highest Position and/or Ranking
Explanation:
 
Special Recognitions/Rankings / Achievements during High School or College career:
1. Year: Title:
2. Year: Title:
3. Year: Title:
 
Other Organized Competitive Sports (Example: Volleyball, Lacrosse, Baseball, sport you lettered in)
1. Other Sport Name: Level: Year(s):
2. Other Sport Name: Level: Year(s):
3. Other Sport Name: Level: Year(s):
Explanation:

 
USTA LEAGUE INFORMATION
Played in USTA League:
List most recent year you played USTA League  
USTA League Year USTA League Section USTA League Division NTRP Level Local or highest Championship reached
Explanation:

 
USTA TOURNAMENT INFORMATION
List most recent year you played in NTRP, Age or Open tournaments:
Divisions you have played: USTA Tournament NTRP levels:
USTA Tournament Age/Open
 
Ranking # Held Year NTRP, Age or Open Singles or Doubles District, Section or National
Explanation:

 
OTHER CONSIDERATIONS
Do you have any special physical or medical conditions that would affect your level of play?
Describe: (be brief and specific -- date of injury, diagnosis, treatment, prognosis and name of attending physician)
Are you currently being treated for an injury that would affect your tennis?
Provide specifics:
List any other information that may impact your tennis history or rating level

 
APPEAL TRUTH STATEMENT
I state the information presented is correct. If it is found that I have falsified or omitted any pertinent information, it may result in disqualification from USTA League Tennis play.
Submitted by:
Name:
These supplementary instructions provide information necessary to complete the appeal form:

Introduction
The Self-Rate appeal form is now linked to the Self-rate Questionnaire. Based on your response to the questionnaire, certain fields may be required to be entered and submitted to file a Self-rate Appeal. It will be possible to submit an explanation when there was an error when completing the questionnaire, and as a result certain fields on the Self-rate Appeal Form should not be required.

Player Contact Info General Information Sport Affiliations (mark N/A if they do not apply) TENNIS EXPERIENCE
Junior History (mark N/A if they do not apply) College History (mark N/A if they do not apply) Professional History (mark N/A if they do not apply) Special Sport Recognition/Rankings Achievements (mark N/A if they do not apply) Other Organized Competitive Sports that you lettered in (mark N/A if they donot apply) USTA League Information USTA Tournament Information Other Considerations Appeal Truth Statement (required)