NIL DISCLOSURE FORM

NIL Disclosure

Mississippi Prep Requires Student-Athlete Disclosure of all Name, Image, Likeness Agreements to TMPH

I am a...

TMP Student-Athlete (or a Student-Athlete's Certified Agent) Business/Outside Individual Contracting with Student-Athlete

Student-Athlete Name

Student-Athlete Sport

Student-Athlete Year at TMP

Student-Athlete Email Address

Additional people you would like to be notified of this agreement (parent, agent, other family member, etc.)

Include name and email address of each individual you authorize to receive. By providing contact information, you are authorizing the release of this data to the individuals listed.

Point of contact at the business (write same name as above if Outside Individual and not a business)

Email for point of contact at the business or outside individual

Phone number for point of contact at the business or outside individual

Type of Endorsement

Please describe the arrangement if selected "Other Self Employment" or "Other Outside Employment" from the list above

Please provide the location of the endorsement. If hosted online, provide the platform (Twitter, Instagram, TikTok, YouTube, Twitch, etc.), handle or account name, and a link if available.

Did you use an online NIL marketplace?

If Yes, please list the name of the online NIL marketplace:

Method of Payment Received by Student-Athlete

Total agreed upon value
*What is the total combined value of payment and/or product the business is paying you for your endorsement. (cash + Venmo + check + product value). (ex. 1,000). If selling own product/service, enter the selling price.

Is there a written agreement?

If the frequency is a set number of times, please list the number of occurrences and/or length of time for the endorsement

Does this agreement require the student-athlete to endorse a product or service while engaging in official activities of the athletics program?

How was this agreement arranged?
Please select all that apply:

Agent Company contacted student-athlete directly (social media, email, phone, etc.) Company contacted student-athlete in-person Company contacted a member of the student-athlete's family Other

Additional Comments Pertaining to this Disclosure

Read and Confirm the Following Statements Required by Mississippi State Law and /or TMP Policies
I have read and attest to the following:*

To the best of my knowledge, the Mississippi Prep, TMP, nor any entity whose purpose includes supporting or benefiting TMP or its athletic program arranged/facilitated the agreement disclosed herein nor provided payment or any other form of compensation for this agreement. Student-athlete did not/will not miss class or a required academic appointment to fulfill this endorsement agreement. Student-athlete did not/will not receive compensation to attend (initial and continued enrollment), participate, or perform at (or for) the Mississippi Prep. I have provided complete and accurate information regarding this activity involving the use of my Name, Image and Likeness or, if submitting on behalf of a student-athlete, the referenced student-athlete's Name, Image, and Likeness. I acknowledge and understand that the NIL-related information contained in this disclosure is provided for notification purposes only to assist TMP in promoting compliance with applicable rules and policies. It is the responsibility of the student-athlete to comply with applicable rules and policies, and receipt of the information by TMP does not indicate approval. TMP cannot provide legal, financial, or other professional advice (including contractual advice and analysis) to student-athletes and this disclosure does not establish an agent-client, attorney-client, or any other fiduciary relationship. While TMP Compliance is available to provide information and answer questions about rules and policies, TMP encourages student-athletes to seek independent professional counsel before entering into any NIL arrangement.

The Mississip Prep