Scholarship Housing Application (Off-Campus Housing) - Partial Scholarship

1. *Last Name:
2. *First Name:
3. *T-Number:
4. *Permanent Address:
5. *City:
6. *State:
7. *Zip:
8. *Permanent Phone:
9. Cell Phone:
10. *Email:
11. *Date of Birth:
12. *Gender: FemaleMale
13. *Class Standing: FreshmanSophomoreJuniorSeniorGraduateTransfer

1. Fall 2013:
2. Spring 2014:
3. Summer 2014:

To be eligible for summer semester, you must be enrolled in at least 9 credits.

1. Single:
2. Family:
   1. Spouse's Name:
   2. Spouse's T-number:

Are you involved in one of the following organizations? (check all that apply)

1. The Michael O. Leavitt Center for Politics & Public Service:
2. The Hispanic Center for Academic Excellence:
3. Music Major:

Please write an essay not to exceed 300 words, describing how this scholarship will aid you in your educational pursuits.

By submitting the Scholarship Housing Application, I agree to comply with the following regulations if I am selected for Scholarship Housing:

I will write a thank you letter addressed to the “Dixie & Anne Leavitt Family Foundation” and submit it to Graeson Keisel in the Financial Aid & Scholarship office at SUU.

I understand that I must maintain full-time enrollment with a GPA of 3.0 or higher to remain eligible for Scholarship Housing. There is not a probationary semester.

I understand that I will be expected to maintain the apartment and will be held responsible for any damage. I agree to hold SUU and/or the property owner harmless and assume all liability unto myself in case of accident, injury, sickness or death as a result of my occupancy of this property.

I agree to take responsibility to be a suitable renter and fulfill all of the obligations outlined in my renter’s contract.

I agree to be a cordial tenant and cooperate with the management of the housing provided and the SUU Scholarship Committee. Failure to do so could put my scholarship in jeopardy.

I understand that I am applying for a PARTIAL housing scholarship redeemable through Leavitt Land & Investment and that I will be responsible for the remaining portion of my rent.

I understand that I may not be in a contract with a different landlord and accept this scholarship. NO EXCEPTIONS.