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Download Ivy Group NCAA Student-Athlete Assistance Fund Request Form
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Ivy Group NCAA Student-Athlete Assistance Fund Request Form 2007-2008 Name _______________________________ Social Security # _______________________________ Sex ________ Institution ________________________ Campus Address ____________________________________ Phone ___________________ E-Mail ___________________________ Home Address (not campus)_______________________________________________________ Year of Graduation ____________________________ Sport(s)_____________________________________________________________ Please describe the purpose for which funds are requested and indicate the amount of the expense, add the total amount of your requested expenses, attach receipts and indicate their total, and sign below. Category Description (specify situation and expense type) Cost Health Insurance __________________________________________ $_______ Emergency Health Expense __________________________________________ $_______ Academic Course Supplies __________________________________________ $_______ Family Emergency (Immediate Family) __________________________________________ $_______ Clothing & Essential Expenses ($500 limit) __________________________________________ $_______ Total Requested $_______ Total Receipts Submitted (must match total requested) $_______ I am currently a member of an intercollegiate team, and have financial need of an emergency or essential nature for which financial assistance is not otherwise available. I agree to provide receipts for these expenses before receiving reimbursement. I understand that this money is considered taxable income and should be declared as such to the Internal Revenue Service. Student-Athlete Signature ______________________________________________________ Date ______________________ -------------------------------------------------------------------------------------------------------------------------------------To be completed by Athletic Authorities on Campus I certify that this student-athlete is participating in intercollegiate athletics at this institution during the 2007-2008 academic year, or is not participating because of medical reasons, or has exhausted athletic eligibility. Athletic Director or designate signature ___________________________________________ Date _______________________ -------------------------------------------------------------------------------------------------------------------------------------To be completed by Financial Aid Authorities on Campus Please check the applicable statement below: For Students who are Pell eligible: _______ I certify that this student is eligible for a Pell Grant for 2007-2008 and has financial need of an emergency or essential nature for which financial assistance is not otherwise available. For Students who are not eligible to apply for Pell Grants because of citizenship status: _______ I certify that this student is not a U.S. citizen and does not have visa status qualifying to apply for a Pell Grant, but has comparable financial need, and has financial need of an emergency or essential nature for which financial assistance is not otherwise available. The student is also receiving countable institutional financial aid. Financial Aid Director or designate signature ________________________________________ Date _____________________ Please attach receipts and forward to: Ivy League Office, 228 Alexander Street, Princeton, NJ 08544 Limit of 3 requests per person annually. All materials must be submitted by May 23, 2008
