NLI/Scholarship Request Form

NLI / Scholarship Request Form
Scholarship Papers are for:
Type of Request
Sport
Anticipated Year of Enrollment
Which Term?

Student-Athlete Name

First NameLast Name
UT ID #
Student-Athlete E-mail

Full Name

First NameLast Name
NCAA ID #
Birth Date

MonthDayYear
Prospect is/will be:
Parent / Guardian Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should an alternate address be used to send scholarship papers?
Alternate Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Period of Award
Length of multi-year scholarship
Student-Athlete is to receive:
Residency

Percentage of Full Scholarship
Tuition and Fees
Room
Board
Books

Multi-Year Percentage

Rows	Percentage
Year 1
Year 2
Year 3
Year 4
Year 5

Multi-Year Allocation

Rows	Tuition and Fees	Room	Board	Books
Year 1
Year 2
Year 3
Year 4
Year 5

Approval / Confirmation
Requested by:

First NameLast Name
E-mail
Signature

Use mouse to draw signature or finger is using a smartphone or tablet.
Date

MonthDayYear
If you have any questions, please contact the Compliance Office at 865-974-2908.
Should be Empty: