OBJECTIVE:: Determine the cardiovascular screening practices of college team physicians. DESIGN:: Cross-sectional survey. SETTING:: Electronic mail with a link to a 9-item survey. PARTICIPANTS:: American Medical Society for Sports Medicine college team physicians. INTERVENTIONS:: Screening practices survey administered to college team physicians. MAIN OUTCOME MEASURES:: Cardiovascular preparticipation screening practices including noninvasive cardiac screening (NICS) such as electrocardiogram (ECG) or echocardiogram. RESULTS:: Two hundred twenty-four of 613 AMSSM members identifying themselves as college team physicians (36.5%) responded: National Collegiate Athletic Association Division I: 146, Division II: 41, Division III: 27, National Association of Intercollegiate Athletics: 8, and Junior College: 2. The majority (78%) of schools conducted the American Heart Association (AHA) 12-element history and physical examination. Division I institutions were more likely to add an ECG and/or echocardiogram (30%) to their preparticipation examination (PPE) compared with lower divisions (P < 0.0001). Those Division I schools using NICS were more likely to do so for all athletes (P < 0.001) or revenue generating sports (P < 0.001), whereas other institutions did so only for high-risk subgroups (P < 0.01). Lower division schools would consider adding ECG if it cost less (P = 0.01) or if there were more local expertise in athlete-specific interpretation standards (P = 0.04). CONCLUSIONS:: Many National Collegiate Athletic Association Athletes Division I programs already use NICS to screen athletes, whereas a significant portion of lower division schools add ECG for athletes deemed high risk. Increased use of these modalities suggests limitations of traditional PPE screening methods. CLINICAL RELEVANCE:: This is the first study to assess cardiac screening practices across all collegiate divisions and broadens our understanding of cardiac screening in high-level athletes. Copyright © 2014 by Lippincott Williams & Wilkins.