• Alternate Usage Request Form

  • This form is to be used for:

    1. Reimbursement of student (out-of-pocket) paid tuition.
    2. Reimbursement of required student related expenses.
    3. Payment made on your behalf for off-campus housing.
    4. Payment made on your behalf for student loan debt.

  • Personal Information:

  • Format: (000) 000-0000.
  • Special Olympics membership is available for youth and adults with intellectual disabilities. Do you have, or would you qualify for, a USBC Special Olympics membership?*

  • Reimbursement of Tuition

    Only to be used for an out-of-pocket tuition payment made to the school, such as cash, check, or credit card. SMART cannot reimburse for student loans, grants or scholarships credited to your student account.
  • Semester - Check all that apply*
  • Do you have another Alternate Usage Request?*

  • Reimbursement of Student Related Expenses

    To be used for student related expenses to include books, supplies and equipment required for enrollment. If approved, a check will be sent to the address on file in your SMART account profile. Limit of one desktop computer/tablet/laptop, etc., every two years. Please see the SMART Policy Manual, Chapter 4 item 2, for a detailed list of items that are/are not covered.
  • Do you have another Alternate Usage Request?*

  • Off-Campus Housing

    Cannot be used for renting from parents, relatives, friends, etc. If approved, the amount will be paid directly to the company/managing owner. Monthly rent will be divided equally by the number of people listed on the lease. SMART cannot reimburse for housing.
  • Do you have another Alternate Usage Request?*

  • Student Loan Debt

    If approved, the amount will be paid directly to the student loan servicer. SMART cannot reimburse for student loan payments.
  • Do you have another Alternate Usage Request?*
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  • Official Signature:

    This form must be signed EACH time you request funds. Without the proper documentation this request will not be approved.

  • By signing this form:

    1. I am affirming these expenses are for my personal use for the class(es) I’m enrolled in and will aid in pursuing my studies.
    2. I understand this transaction may have an adverse effect on my collegiate eligibility.
    3. I understand to ensure compliance for collegiate competition, I should check with the compliance officer and/or athletic/activities association.
    4. I understand this could affect my financial aid and I should check with the financial aid office.
    5. I acknowledge there may be income tax consequences and it is my sole responsibility to obtain such advice as I deem necessary regarding any potential tax consequences to me. SMART is not responsible for any tax liabilities that may occur as a result of this disbursement of funds.
    6. If I am determined to have submitted this application or other documents in an effort to defraud SMART, I understand this could result in my suspension by the United States Bowling Congress, and I may have to pay the funds back and/or forfeit my remaining funds in my SMART account.
    7. SMART possesses sole authority to modify its policies and procedures and any such modification shall be binding upon me, effective the date it is publicly announced.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: