FINANCIAL AID OFFICE 1900 West Olney Avenue Philadelphia, PA 19141-1199 Phone: 215.951.1070 Fax: 215.951.5098 www.lasalle.edu finserv@lasalle.edu 2020-2021 Student-Athlete Outside Aid Award DIRECTIONS: Before you can be certified for competition for the upcoming semester, you and other designated individuals, as indicated, must complete each section of this form Please return the completed form by fax to 215.951.5098 or send by mail to Athletic Financial Aid Coordinator, La Salle University Financial Aid Office, Administration Building, 1900 West Olney Avenue, Box 811, Philadelphia, PA 19141 You must complete a separate form for each scholarship you receive PART Student-Athlete Certification Please complete the information below Student-Athlete Name (last, first, middle) and La Salle ID number : Sport: Check one and certify the statement with your signature below I have not received, nor I expect to receive, a financial award to further my college education other than the financial aid awards from La Salle University or a Federal Pell Grant No additional information is required Sign below and return to the address listed above I have received a financial award to further my education from an agency other than La Salle University Please have a member of the awarding agency’s selection committee complete the remainder of this form and return it to the address listed above I am not receiving an outside scholarship but I have a prepaid college tuition which has been purchased by a family member Plan Name: Purchased By (e.g grandparents) _ Student-Athlete’s signature: Date: PART AWARD CRITERIA- to be completed by a member of the awarding agency’s selection committee Name of La Salle University Student-Athlete: Sport: Please answer the following questions regarding the award and selection criteria that apply to this student Name of Award Amount $ List below ALL criteria used in the selection process You may attach a listing or the student’s application to this form Please answer each question below to identify the basis of the award decision Are only student-athletes considered for this award? Yes No Are applicants requested to list extracurricular activities on the application form? Yes No If yes, did the applicant list extracurricular activities that included athletic participation? Yes No Rev 07/2018 Please check the statement that best indicates the importance given to the recipient’s athletic ability and athletic participation in the selection process The award was made on the basis of the recipient’s past performance and overall record, as measured by established criteria of which athletic participation was a major criterion The award was made on the basis of the recipient’s past performance and overall record, as measured by established criteria of which athletic participation was a minor criterion The award has no relationship to athletic ability or participation Please describe your scholarship program by answering yes or no to the following questions Is this an established, continuing scholarship program formed to recognize outstanding high school graduates? Yes No Is the awarding individual, organization, and/or donor of this scholarship aid a representative of the athletic interests and/or athletic booster of La Salle University? Yes No Is the recipient eligible to receive this aid if enrolled at any accredited institution in the United States? Yes No Will this scholarship be reissued to this recipient in subsequent years? Yes No Have the funds for this award already been disbursed to the recipient? Yes No If funds are to be disbursed after the recipient’s initial collegiate enrollment, NCAA rules require that the student-athlete's award funds be disbursed through La Salle University Please forward the funds to: Athletic Financial Aid Coordinator, La Salle University Financial Aid Office, Administration Building, 1900 West Olney Avenue, Box 811, Philadelphia, PA 19141 Name of authorized individual who provided award criteria information: Phone number Title Institution, agency or funding organization Address Signature E-mail address City Fax number State Date Zip Code