NCAA Student-Athlete

SPECIAL ASSISTANCE FUND

Application

Name:_____________________________ ID No.:____________________________

Sport: _______________________________ SSN: _____________________________

Receive Athletic Scholarship: Yes No Athletic Eligibility Remaining: Yes No

Academic Classification: Freshman Sophomore Junior Senior Fifth Year

Are you a US Citizen: Yes No

If yes, have you completed a Free Application for Federal Student Aid (FAFSA) and been certified eligible to receive a Pell Grant? Yes No
If no, have you completed a Special Assistance Needs Analysis Form (SANAF) for International Student-Athletes? Yes No
Applications cannot be considered until a financial need has been documented using either the FAFSA (Pell Grant Application) or the SANAF.

Purpose for which aid is requested. SAG is limited to the following categories only.

___ Medical/Dental/Visual/Hearing Expenses (Describe): _________________________

________________________________________________________________________

___ Emergency Travel (Describe):____________________________________________

________________________________________________________________________

___ Course Supplies (Describe): _____________________________________________

________________________________________________________________________

___ Clothing

___ Health Insurance

Amount Requested: $_________________ (The Athletics Department must limit the maximum amount a student-athlete may receive per year. The limit will be determined annually based upon the amount received from the NCAA and the number of qualified student-athletes. The NCAA limit for clothing is $500 per year. All other expense requests must be verified with a written estimate or receipt to be attached to this form).

Student-Athlete

I certify that the information above is correct. If approved, I understand that this money can be used only for the stated purpose above.

______________________________________ ______________________________

Signature Date

FOR OFFICIAL USE ONLY

Athletic Department’s Representative

The student-athlete named on this form is an official member of a NCAA sponsored Nicholls State University athletics team (name appears on the official Squad List). The request has been reviewed, entered into the data base, and transmitted to the Director of Financial for approval.

_______________________________________ _____________________________

Signature Date

Director of Financial Aid

________ Approved or ________ Disapproved Date: _____________________

Athletic Dept. Business Office

Check request submitted to the Accounting Office Date: ____________________
Check received from Accounting Office Date: ___________________

Disbursement

Check mailed to __________________________ Date: ___________________

(Name of service provider)

Check issued to student-athlete on: _____________________________________

I have received my check in the amount of $______________ on this date and understand that this money can be used only for the purpose for which it was requested as reflected on the front of this form. Receipts will be returned on all services and non-expendable expenses.

____________________________________

Signature

____________________________________

Date

INSTRUCTIONS

Qualifications to Receive a Special Assistance Fund. Special Assistance Funds are based on financial need. Students who have not demonstrated a “need” are not eligible to receive the Special Assistance Fund. If a student is eligible for a Pell Grant they have demonstrated “need” and are eligible for the Special Assistance Fund.

Processing Procedure. Student-athletes should contact the athletics director concerning any requests for special assistance funds.

Time. It will take approximately two and a half weeks from the time a completed application is received until the check is ready for pick-up.

Individual Limits. The amount of money provided to each institution by the NCAA is limited and based upon the number of Pell Grant recipients from the previous year. The amount of money received may be more or less than the number of eligible applicants in a given year. There will never be enough money to pay for every request from every eligible applicant. Therefore, the Athletics Department must cap the amount of money a single student-athlete may receive regardless of need. The individual limit will be determined at the beginning of each year based upon the amount of money available and the number of student-athletes who project to have unmet financial needs.

For the 2005-06 year, student-athletes are limited to a maximum of: $200.