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METRO ATLANTIC ATHLETIC CONFERENCE NCAA SPECIAL ASSISTANCE FUND 2006-07 Application Form Student-Athlete:_____________________; Sport:_______________; Pell:_____; Athletic Aid with Unmet Need:______ Institution:_________________________; Male:________ Female: ________; *International Student:_________ Conference: Metro Atlantic Athletic Conference Purpose for which funds are requested: AMOUNT 1. Medical Expenses (except those covered by another insurance policy), including optional institutional medical insurance premiums. 2. Hearing Aid ________ 3. Vision Therapy ________ 4. Off-Campus Psychological counseling ________ 5. Costs associated with student-athlete or family emergencies ________ (Include written description of emergency) 6. Purchase of expendable course supplies (e.g. notebook and pens) ________ 7. Rental of non-expendable course supplies (e.g. computer equipment and cameras ________ that are required for all students enrolled in the course.) 8. $500 Allowance ________ Clothing Essentials Transportation home from the institution TOTAL AMOUNT: ________ If request includes money for clothing, shoes, or other essentials, please indicate the total amount the student-athlete has received during the 2004-05 academic year: ____________________________________. As the applicant, I verify that I am a PELL GRANT athlete who is participating on a varsity team or a student-athlete who is receiving countable athletically related financial aid and has demonstrated need as determined by the financial aid office. Non-qualifiers may not receive special assistance funds during their first academic year in residence. All SA?s who qualify for the fund have access to all categories of the fund. *For a foreign student-athlete, an official foreign student-athlete advisory entity of the institution outside the athletic department must certify in writing that the student-athlete has a financial need. Please send documentation to the conference office. Student-Athlete Signature Date Director of Athletics/Senior Women?s Administrator Date A D E G H [ G k ) * + / ^ ? ? O V A e h i k ? ? ? ?????????????p????_?_?_?W h?1s h?m? >* h?1s h?m? >*B*CJ aJ ph )h?m? h?m? B*CJ OJ QJ ^J aJ ph h?m? h?m? >*B*CJ aJ ph h?1s >*B*CJ aJ ph #h?m? h?m? 5?B*CJ \?aJ ph h?m? h?m? B*CJ aJ ph h?O? 5?B*CJ \?aJ ph #h?m? h?m? 5?B*CJ \?aJ ph h?m? h?m? 5?B*\?ph h?m? h?m? B*ph $ A I Z [ ? ? : ; j k ? ? ? . / P Q u v ? ? D ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?P??7$ 8$ H$ ^?P`??gd?I? $7$ 8$ H$ a$gd?m? 7$ 8$ H$ gd?m? ? ? 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