Cancellation or

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Student-Athlete Receiving Financial Aid Reduction/ Cancellation or Roster Change Form Date

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SPORT

Student-Athlete ROSTER CHANGE

ID (if you intend only to reduce or cancel aid and the SA is to continue participation, please skip this section of the form)

The student-athlete (SA) named above will not longer be participating as a member of the team. Please remove him/her from the roster for the following reason:

Cut from Team

Quit Team

Effective Date:

With this action, I recommend the following action for any remaining Financial Aid due to the Student-Athlete (this action will be taken immediately):

Allow SA to receive remaining Aid for term of contract

Cancel Aid

Reduce Aid

If the SA's athletically related aid will be affected by this action, please complete the information below.

REASON FOR CANCELLATION OR RECUATION OF ATHLETICALLY RELATED FINANCIAL AID:

Student-athlete deemed himself/herself ineligible for intercollegiate competition. The student-athlete fraudulently misrepresented information on an application, letter of intent, or financial aid agreement. The student-athlete engaged in serious misconduct resulting in disciplinary penalty from the institution: Please provide a brief description:

The student-athlete voluntarily withdrew from a sport at any time for personal reasons (student-athlete must complete bottom portion of this form) The student-athlete violated the Student Athlete Code of Conduct per his/her contract.

VOLUNTARY WITHDRAW I have voluntarily withdrawn from participation in my sport. I understand that the NCAA allows for my aid to be cancelled or reduced immediately upon my voluntary withdraw from participation for personal reasons. I also understand that I have a right to appeal the cancellation or reduction of my aid and will do so within 14 days of signing this document if I feel my aid has been unfairly cancelled or reduced. I have discussed this issue with my head coach and, by signing below, I consent to my voluntary withdraw from participating as a member of the Montana State University athletics program. Student-Athlete Signature

ID

Date

Head Coach Signature

COMPLIANCE OFFICE USE ONLY APPROVED? Date Submitted: COMPLIANCE SIGNATURE OF APPROVAL NOTES:

Date

YES

NO Date Approved: Updated 5/2013