Southern Illinois University Edwardsville



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Southern Illinois University Edwardsville

DEPARTMENT OF INTERCOLLEGIATE ATHLETICS


5th Year Academic Support

2016-2017 APPLICATION




(Only student-athletes who have exhausted their eligibility are eligible)

Each portion of the application must be fully completed and turned into Associate Athletic Director for Compliance & Student Services (Jaci DeClue) by the application deadline – Friday, March 4, 2016.
S T U D E N T - A T H L E T E T O C O M P L E T E T H I S S E C T I O N•
NAME: ____________________________________ FALL 15 SEMESTER GPA: ___________________
SPORT: ___________________________________ CUMULATIVE GPA: ___________________________

LOCAL PERMANENT

ADDRESS: _________________________________ ADDRESS: ___________________________________
_____________________________________ ______________ ________________________________________________________________
PHONE NUMBER: (__ __ __) __ __ __ - __ __ __ __ EMAIL: _________________________________
MAJOR: ____________________________________ MINOR: ________________________________________


  1. Anticipated graduation from SIUE? FALL SPRING SUMMER YEAR: 16 17

  2. Where will you live during your 5th year? ON-CAMPUS OFF-CAMPUS

  3. Number of hours remaining to graduate after completion of Spring 16? _____________

  4. Anticipated enrolled hours: Summer 16 _______ Fall 16 _______ Spring 17 _______ Summer 17 _______

5

Policies and Guidelines for The



5th Year Aid Scholarship
th Year Academic Support applications will be reviewed on an individual basis using the following terms and conditions:
1. Any student-athlete who is finishing his/her eligibility can apply for academic assistance for the following year under the 5th year academic support program (for undergraduate program completion assistance – tuition only). NCAA rules limit student-athletes to 10 semesters of athletic aid over a five-year period.
2. To be eligible for 5th year academic support, you MUST be in good academic standing at the beginning of your 5th year aid period (2.00 or above cumulative grade point average) and have earned at least 24 hours towards your designated degree in the previous academic year. Waivers of any part of this policy must be made by the Director of Athletics.
3. Renewal of 5th year support is reviewed on a semester-by-semester basis. You do not need to fill out an additional application. To continue to be eligible for the 5th year academic support, you MUST earn at least 12 hours towards your degree (or number of hours needed for degree completion if less than 12) with a 2.0 GPA in the previous semester. Waivers of any part of this policy must be made by the Director of Athletics.
4. As a condition of accepting 5th year aid, you will be expected to provide certain services to the Athletic Department eight hours per week (i.e., work in the Department of Intercollegiate Athletics, event management, concessions, tutoring, ticket sales, field maintenance). If at any point you are deemed to be uncooperative in assisting the Athletic Department, your 5th year aid may be reduced or cancelled.

By signing below, you certify that:

  1. You have read and understand the Athletic Department’s policies and guidelines pertaining to Fifth Year Academic Support that are stated above and you agree to abide by these policies and guidelines in the event you receive such aid.

  2. All of the information you have provided on this application is true and correct to the best of your knowledge.

  3. You will notify the Department of Intercollegiate Athletics as soon as possible (no later than the first day of classes) in the event that you decide not to or are unable to use the 5th year academic support assistance program.

Signed: ______________________________________________



Student-Athlete Signature Date
DEPARTMENTAL ACADEMIC ADVISOR/FACULTY ADVISOR TO COMPLETE THIS SECTION•

(Section to be completed BEFORE application is filed with the Associate Athletic Director)
Declared Major: ____________________________ Declared Minor: ____________________________
Cumulative GPA ____________________

Has student-athlete applied for graduation? YES NO N/A


How many estimated hours does student-athlete have remaining to graduate after the spring 2015 term (assuming the student- athlete passes all spring hours that count towards his/her degree progress)? ______________

What are those remaining courses after spring term? ­­­­­­­­­________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________
When do you expect this student-athlete to graduate? Fall Spring Summer YEAR: 15 16
Any additional circumstances to consider/comments: _________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________


Signed: __________________________________________________________________

Departmental Academic Advisor/Departmental Faculty Advisor Date

STUDENT-ATHLETE TO COMPLETE THIS SECTION•



(Section to be completed BEFORE application is filed with the Associate Athletic Director)
Names of classes you plan to enroll in during Summer 2016 semester (example ACS 305): __________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Names of classes you plan to enroll in during Fall 2016 semester (example SOC 302): ______________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________


_____________________________________________________________________________________________________________

Names of classes you plan to enroll in during Spring 2017 semester (example HIST 300): ___________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________


_____________________________________________________________________________________________________________

Names of classes you plan to enroll in during Summer 2017 semester (example MC 481): ___________________________



____________________________________________________________________________________________________

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