J uty StrJDl3
Uad,(tn-', rllo oFFrcrAL usE,NLY X F"ll
Type ofAssistance
-spriod
Tuition
"t
J Boot.
Curn. GPA
Books O''lv
App"o.,"J
-Not
App"o.'.J Circle one:
A,rnount A*.J"J
Date Received:
R".eit"J
Ly,
SOUTHERNUNIVERSITY SYSTEM FOUNDATION APPLICATION FOR EDUCATIONAL ASSISTANCE Directions,
Pl"r""
Applic.rtt's
cornplete all section" of thi" applicatio.r.
.Writ"
N/A;f
sections Jo not -pply.
Typ.
or print
in int.
Parish or County
Persortrl Ittformation
SID#:
Narne Permane
nt AJJr"ss CitylStatelZip
Street
CiqlSutelZip
Lo""l AJ Jr.r" S"*
Bi*hJ"y Parent(s) Grr"tJian
Martial
)
T"l"photr* (
)
Nrrrrrt"t o[ D"p"trJents-
Stat rt
Narne
AJJ'...
(
T"l"pl'ott.
Parent(s)/Gr'"*Jian(s) o[ D"p"ttJents
Parent(s)/Gn"tJian(s)
)
CitylStatelZip
Street
N.rt rt"t
(
T"l"photr. Street
Ernployrnent {ot Prrunt(s)/Gur.Jirtt(s) Incotn. Rangfe:
LI.J".
- $1O,OOO
- $2o,ooo $to,ooo - $ao,ooo $zo,ooo - $ao,ooo $ao,ooo - $5o,ooo $ao,ooo $50,ooo- Ov.* Applicrnt's Employrnent Irrfor*rtion
Plrc.
T.l.phon. (
o{ Et tployrnent
No. of HorrrsNf""L
Monthly
)
Incorne
Spo.ts" Narne
Monthly
Spo.r." Ernployment
T"l"photr"
Incorne
(
)
Applicrnt's
Ir.{or..rrtion
E Jucational
SUCAMPUS:
STI-BR
Clrssification:
SULC
Ft .h*.r.
SUSIA
SUNO
-sopltornore
Ivlajor
Minor
High S.hool
Date GtrJ.tateJ
Gi.ru
"
t;"{
Jescriptiot
Appli"rnt's
o{ your coll"g"/high
"lnL.,
Have you previo.tsly."c.iveJ
I h-.r. rlr.tJy
tk"t
t".t
previous
"*rtJ.J
ftorn th" SU Systern FounJation
C.rrr.tlrtive
Jo..
not gfuarantee continrrorr"
frrr,Jittg)
thu followinel assistance (List ALL sourcesit cLrJirrglo.rrs, pfrants,,"hol.""hi
assistance
I certify tLat tLe in{onrnation pro"iJ"J "[
No
assistanc. ftor., the SU System FounJation f..t Jng
li"J [o' th. {ollowin
Signature
school activities anJ r.hi".r"r.rents:
o{fi".. h.lJ, hoLbi"., athletics, etc.)
E J.rcationaVFinancial A*.tJt
(Please .rnJerstanJ
I hr.r. t
StuJent
Zip C.,l"
Strte
(scholrstic awa.Jr,
Date
GraJuate
Senior
Junior
City
ExpecteJ G.aJ.tation
List ALL
sources incl.tJin
lo.rt.,
ts, s.holar"hi
ott thie application is true and correct b tLe Lest of tt y ttro*l"dg.. Date
Applicant
ACT/SAT Soo".
GraJe Point Averagfe
Pl.r.. attach the followinel: .Offici.l
t '.r-ipt
Renrne I tlrec applicaotr)
1d cateriag Frerlrnrlr (3) l"tt
'r
"{
-Copy
o{
2013 FJI
-Copy
o{
2013 F"ll
ot T'..J"'
'.o"'o'o"lrJ.uo"
St"l".t),
({o' {i'*
"th""-ie.
ti'rre applicrntr)
a copy o{ your lrrogt cfftenV2013 OR oac (1) letter J '."o-ae'rlatio!
Sprlng *aJ rcpo* 60r continuind
Lilli"g staternent .1... r.L.d.'I.
Southern University Systern FounJation Post O[fi"" Box 9562 r Baton Rougfe,IA 70813 Attention: EJucatiotrrl A*ristance Cornrnittee Revised 1/06
ste-f#1;) frerrl't Sy sout tniversity
h:' ##,,e
3'd Floot, I.S. Cl""h AJrninistration B,rilJing
Post O{fi". Box 9562 Baton Rougfe, Louisiana 70813
Fax #' (225\ 77L-3242
Phor'. #, Q25\ 771-39LL
BOOE.rllv'.,fnD SprinE Semester2AL3
Natne o{ StuJent
SID#'
Narne o{ S.tppli.t
T"lrphone #t
AJJr"ss t C;tylStatelZip
Street
Description
Quantity
Total arnount of of[i"i"l
quote:
$
Signature of A..thoriz"J
I},ITON
Amount
R.p".".t.tative
ROI-GN
o{ S..ppli""
. \EWORI..E.IIS
Date
. STIREVNPORT
. BOSSIERCITY R.wiseJ 1/06