OUTSIDE SCHOLARSHIP FORM - Plymouth State University

STUDENT FINANCIAL SERVICES

17 High Street, MSC 19 ? Plymouth, NH 03264 ? Fax 603?535?2627 ? Phone 603-535-2215 ? Toll Free 877-846-5755

OUTSIDE SCHOLARSHIP FORM

Student Name:___________________________________________________ PSU ID#:____________________________________

Please list any scholarships, grants, or prizes you have been awarded by your school, church, community, employer, parents' employer (example: USNH Staff Tuition Benefit) or any other non-PSU organization. If you would like your outside scholarship applied to the fall or spring tuition bill, please be sure to read and complete all sections of this form, sign, and submit it to our office along with a copy of the scholarship award letter(s). You may scan and email the completed form and award letters to us at psu-studentaccount@plymouth.edu or mail them directly to Student Account Services at the address above. Scholarship checks must be made payable to Plymouth State University; if a check is made out directly to the student, please write `Pay to the order of PSU' on the back, endorse it, and mail directly to Student Account Services. It may be necessary to adjust your financial aid package based upon the incoming scholarships, since your demonstrated financial need

may change. In most cases, we will allow the outside resource to fill "unmet need", then to replace all or part of your loan or

work study allocation first before adjusting any institutional need-based scholarship or grant.

Award Name

Amount to be Amount to be

Total for

applied to Fall applied to Spring Academic Year

PLEASE NOTE: Scholarships can be applied to the student's account in advance of receiving the actual payment from the scholarship sponsor, if the scholarship award letter states all of the following:

Student Name

Mailing Address of Scholarship Sponsor/Organization

Name and Amount of Scholarship Semester for which the Scholarship is to be used

EXCEPTION: If an award is dependent upon grades, completion of a term and/or proven "financial need", it is not guaranteed and will NOT be counted as pending payment on the tuition bill. In such cases the bill will need to be paid by other means. (Should the scholarship come in later the student can request a refund of any overpayment.)

-The information requested on this form is required to ensure compliance with federal regulations -

Do you plan on playing a Division III NCAA sport while at PSU? YES NO (please circle)

If YES, did any of these scholarships, grants, outside funding have an awarding criteria that included your athletics leadership, ability, participation or performance? YES NO (please circle)

If YES, please list: _____________________________________________________________________________________________________________

NCAA 15.2.3.5.1

It is not permissible for a student-athlete to receive financial aid, directly or indirectly, from a source outside the ins tu on

(e.g., a foreign government, a sports associa on, a high school booster club) for expenses related to a endance at a member

ins tu on, if the award of such financial aid is based in any degree upon the recipient's athle cs leadership, ability, par cipa-

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Student Signature:_________________________________________________________________ Date:______________________

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