SPECIAL ASSISTANCE FUND FOR STUDENT ATHLETES APPLICATION FORM 2011 - 2012 SAOF is used to provide special financial assistance to NAU student-athletes to cover clothing costs, transportation costs, medical costs, academic supply costs or emergency costs. This fund is limited in resources and the application process is important. All students are eligible for medical expenses and/or emergency expenses at any time. The receipt of funding for clothing and/or expendable academic expenses in previous years will be taken into account when funding is disbursing funds for the current academic year. All applications must be accompanied by either receipts (for expenses already incurred) or detailed estimates/ invoices (for planned purchases) This form should be completed by the student-athlete and must be turned in no later than Friday December 2nd.
(PLEASE PRINT) Students’ Last Name
NAU ID Number
$ Total Amount Requested
Section I Purpose of the request (please check): Clothing _______ Transportation _______ Academic Supplies _______ Medical/Dental Expenses _______ Emergencies _______ Other _______ Please explain the circumstances that have led to your requesting to receive the special assistance fund for student-athletes. Be detailed in describing why you feel you deserve the funding to cover the purchase you have made. Attached additional pages if necessary.
Section II (INTERNAL USE ONLY) FAFSA Completed? Yes _____ No ______ Approved? _____ Yes _____ No
Pell Grant Recipient? Yes _______ No _______
If approved, partial or full?
Partial _____ Full _____
We certify that to the best of our knowledge the information contained herein is accurate and correct. Further, we certify that we have reviewed the Guidelines of the Use of the Special Assistance Fund and that this request does indeed qualify under those guidelines.
Student Athlete Signature & Date
Director of Athletics or Designee Signature & Date
Director of Compliance Signature & Date