western kentucky university athletics compliance office
WESTERN KENTUCKY UNIVERSITY
ATHLETICS COMPLIANCE OFFICE
REQUEST FOR NATIONAL LETTER OF INTENT/FINANCIAL AID AGREEMENT STUDENT NAME: (FIRST/MI/LAST) __________________________________________ SPORT: __________________________ ELIG. CENTER ID #: _____________________ DATE OF BIRTH: ________________ EMAIL: __________________________ ADDRESS: __________________________________________________________________________________________ STREET/BOX
CITY
RESIDENCY: IN-STATE ____
OUT-OF-STATE ____
NCAA ACADEMIC STATUS
YEAR IN SCHOOL: (SELECT ONE)
QUALIFIER ____
HIGH SCHOOL SENIOR ____
NONQUALIFIER ____
2-YEAR COLLEGE TRANSFER (1ST YEAR) ____
NOT DETERMINED ____
EXPECTED GRADUATION DATE: (FOR HS SENIOR OR 2-YEAR COLLEGE NONQUALIFIER) ____________
DOCUMENT(S) REQUESTED:
TIP ELIGIBLE ____
STATE
ZIP
INTERNATIONAL (LIST COUNTRY) _____________________
CURRENT WKU STUDENT ____
4-YEAR COLLEGE TRANSFER ____
2-YEAR COLLEGE TRANSFER (GRADUATE) ____
NLI WITH FINANCIAL AID AGREEMENT ____
FINANCIAL AID AGREEMENT ONLY ____
WILL THE STUDENT RECEIVE A WKU ACADEMIC SCHOLARSHIP? YES ____ NO ____
IF YES, LIST SCHOLARSHIP(S) AND AMOUNT(S): ______________________________________
GRANT-IN-AID AMOUNT/LENGTH: (CHECK ONE)
SINGLE YEAR ____
MULTI-YEAR ____
FIRST FULL-TIME TERM OF ENROLLMENT AT WKU (IF INCOMING):
FALL 2017____
SPRING 2018 ____
FALL 2018____
AMOUNT OF ATHLETICS AWARD: (BASED ON 2016-17 RATES) ____________ (PERCENTAGE OR $ AMOUNT) IF MULTI-YEAR, SPECIFY PERCENTAGE OR $ AMOUNT FOR EACH YEAR 2017-18 _____
2018-19 _____
2019-20 _____
2020-21 _____
2021-22_____
2022-23_____
DISTRIBUTION: _______________________________________________________________________________________ (FOR SCHOLARSHIPS LESS THAN 100%, USE THIS SPACE TO REQUEST A DISTRIBUTION OTHER THAN BOOKS, TUITION, FEES, ROOM, BOARD, THEN O THER EXPENSES FOR COST OF ATTENDANCE.)
HOUSING CHOICE:
OFF-CAMPUS ____
ON CAMPUS ____
IF ON CAMPUS, SPECIFY DORM: _____________________________________________________ NLI/FAA DELIVERY METHOD: SCAN/EMAIL____ REGULAR MAIL____ HEAD COACH SIGNATURE: _________________________________________
DATE: ____________________________
**PROVIDE THIS COMPLETED FORM TO THE COMPLIANCE OFFICE WHICH WILL PREPARE TWO SETS OF DOCUMENTS AND RETURN TO THE HEAD COACH. THE HEAD COACH IS RESPONSIBLE FOR FORWARDING THE DOCUMENTS TO THE PROSPECT AT THE APPROPRIATE TIME FOR THE PROSPECT’S SIGNATURE.**
FOR COMPLIANCE OFFICE USE ONLY: AMATEURISM QUESTIONNAIRE DATE: ________ PERMISSION TO CONTACT ON FILE? YES ____
IRL DATE: ________ NO ____
N/A ____
TRANSCRIPT RECEIVED? YES ____ NO ____ TEST SCORES RECEIVED? YES ____ NO ____ N/A ____
APPROVED BY COMPLIANCE: _______________________________________
DATE: ___________________
ATHLETICS COMPLIANCE OFFICE
REQUEST FOR NATIONAL LETTER OF INTENT/FINANCIAL AID AGREEMENT STUDENT NAME: (FIRST/MI/LAST) __________________________________________ SPORT: __________________________ ELIG. CENTER ID #: _____________________ DATE OF BIRTH: ________________ EMAIL: __________________________ ADDRESS: __________________________________________________________________________________________ STREET/BOX
CITY
RESIDENCY: IN-STATE ____
OUT-OF-STATE ____
NCAA ACADEMIC STATUS
YEAR IN SCHOOL: (SELECT ONE)
QUALIFIER ____
HIGH SCHOOL SENIOR ____
NONQUALIFIER ____
2-YEAR COLLEGE TRANSFER (1ST YEAR) ____
NOT DETERMINED ____
EXPECTED GRADUATION DATE: (FOR HS SENIOR OR 2-YEAR COLLEGE NONQUALIFIER) ____________
DOCUMENT(S) REQUESTED:
TIP ELIGIBLE ____
STATE
ZIP
INTERNATIONAL (LIST COUNTRY) _____________________
CURRENT WKU STUDENT ____
4-YEAR COLLEGE TRANSFER ____
2-YEAR COLLEGE TRANSFER (GRADUATE) ____
NLI WITH FINANCIAL AID AGREEMENT ____
FINANCIAL AID AGREEMENT ONLY ____
WILL THE STUDENT RECEIVE A WKU ACADEMIC SCHOLARSHIP? YES ____ NO ____
IF YES, LIST SCHOLARSHIP(S) AND AMOUNT(S): ______________________________________
GRANT-IN-AID AMOUNT/LENGTH: (CHECK ONE)
SINGLE YEAR ____
MULTI-YEAR ____
FIRST FULL-TIME TERM OF ENROLLMENT AT WKU (IF INCOMING):
FALL 2017____
SPRING 2018 ____
FALL 2018____
AMOUNT OF ATHLETICS AWARD: (BASED ON 2016-17 RATES) ____________ (PERCENTAGE OR $ AMOUNT) IF MULTI-YEAR, SPECIFY PERCENTAGE OR $ AMOUNT FOR EACH YEAR 2017-18 _____
2018-19 _____
2019-20 _____
2020-21 _____
2021-22_____
2022-23_____
DISTRIBUTION: _______________________________________________________________________________________ (FOR SCHOLARSHIPS LESS THAN 100%, USE THIS SPACE TO REQUEST A DISTRIBUTION OTHER THAN BOOKS, TUITION, FEES, ROOM, BOARD, THEN O THER EXPENSES FOR COST OF ATTENDANCE.)
HOUSING CHOICE:
OFF-CAMPUS ____
ON CAMPUS ____
IF ON CAMPUS, SPECIFY DORM: _____________________________________________________ NLI/FAA DELIVERY METHOD: SCAN/EMAIL____ REGULAR MAIL____ HEAD COACH SIGNATURE: _________________________________________
DATE: ____________________________
**PROVIDE THIS COMPLETED FORM TO THE COMPLIANCE OFFICE WHICH WILL PREPARE TWO SETS OF DOCUMENTS AND RETURN TO THE HEAD COACH. THE HEAD COACH IS RESPONSIBLE FOR FORWARDING THE DOCUMENTS TO THE PROSPECT AT THE APPROPRIATE TIME FOR THE PROSPECT’S SIGNATURE.**
FOR COMPLIANCE OFFICE USE ONLY: AMATEURISM QUESTIONNAIRE DATE: ________ PERMISSION TO CONTACT ON FILE? YES ____
IRL DATE: ________ NO ____
N/A ____
TRANSCRIPT RECEIVED? YES ____ NO ____ TEST SCORES RECEIVED? YES ____ NO ____ N/A ____
APPROVED BY COMPLIANCE: _______________________________________
DATE: ___________________
