SAF

CLOTHING/PERSONAL/ACADEMIC SUPPLIES/OTHER

REQUEST FORM

Student-Athlete: / Sport(s): / Academic Year (Check one):
_Freshman _Sophomore _ Junior
_Senior _5th Year Senior
G#: / Male/Female / Permanent Address:
Dormitory Building/Off- Campus Address: / Phone: / Email:
Pell Grant Eligible: / Yes: / No:
Please check the following as it pertains to your athletic scholarship: / Full: / Partial: / None:
Are you an International Student-Athlete? / Yes: / No:
Please mark the type of reimbursement that you are requesting below:
___CLOTHING
___PERSONAL SUPPLIES
___ACADEMIC SUPPLIES
___OTHER
Please state the following regarding your reimbursement request:
Date of Purchase / Store Location / Number of Items Purchased / Items Purchased / Cost of Items
Ex: 9/15/2010 / Target / 5 / Notebooks, Pens, Pencils / 35.15
Please explain your reasons for applying for clothing/personal and academic supplies reimbursement through the NCAA Student-Athlete Aid Fund.
Student-Athlete Signature: Date:
Administrative use only
TOTAL MONIES REQUESTING FOR REIMBURSEMENT:
______
Approved by: Date:
Please print and return form to Ms. Resa Lovelace with ALL appropriate attachments.

All forms must be printed out and turned in with appropriate attachments

Clothing/Personal/Academic Supplies/Other

Reimbursements

POLICY STATEMENT:

Student-athletes have the opportunity to request reimbursement on clothing/personal articles and academic supplies throughout the course of the academics school year. All applicants are eligible to receive up to $250 reimbursement for the entire school year. By reducing the allotment, the fund can be granted to more student-athletes who express the need for the fund.

In order to be in contention for reimbursement through the NCAA Special Assistance Fund, student-athletes must be on the team roster of an NCAA sponsored sport at George Mason University, qualify academically, and complete the FAFSA application for the current year. Once approved, the applicant must provide clear and organized documentation of receipts and other validations of purchases. A failure to adhere to the following requirements will ultimately result in a disqualification for reimbursement requests.

Please note the following for specifics regarding reimbursement:

  • Faded or crumbled receipts with vague or no information will not be accepted
  • The receipts must have the date and place in which they were purchased
  • The clothing/articles purchased MUST be gender specific purchases to ensure that they were intended only for use of the person who purchased them and not someone of the same or opposing sex.

Receipts for the following list of items DO NOT qualify for reimbursement*:

  • Jewelry
  • Body lotions, specialty soaps, lingerie
  • Food
  • Hand bags/wallets, cell phone bills,
  • Books, computers, printers, and lap-tops.

We WILL accept receipts for the following items*:

  • Suits, dresses, pants/shirts, shoes,
  • Pots and pans, dishes
  • Winter hats/gloves
  • Laundry detergent
  • School supplies (not books)

*This is not a complete list of both permitted and prohibited items.

For more specifications, please see Nena Rogers, Director of Life Skills () or Resa Lovelace, Coordinator of Life Skills ()

For more information

Submission Dates

Fall / Winter / Spring
Sept. 15 – Dec. 20, 2010 / Nov. 1, 2010 – Feb. 28, 2011 / Feb. 1 – May 6, 2011
Women’s Volleyball / Men’s & Women’s Basketball / Lacrosse
Men’s & Women’s Cross Country / Men’s & Women’s Swim & Diving / Softball
Men’s & Women’s Soccer / Men’s & Women’s Indoor Track / Baseball
Volleyball / Men’s & Women’s Outdoor Track
Wrestling / Golf
Rowing / Men’s & Women’s Tennis

Acknowledgement of Policies and Procedures:

I hereby recognize the statements above as the primary means in which I can receive reimbursement up to the maximum amount of $250 for the entire school year for my clothing/articles and academic supplies purchases. By signing this document, I understand that I am not GUARANTEED full reimbursement for any of these purchases. I also recognize that if I do not provide the documentation necessary to prove my identity and purchases, I disqualify my chances of receiving reimbursement for any or all of my purchases.

Signature of Agreement: ______

Printed Name: ______

Date: ______