2023-Academic Scholarship Application

Student Information

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Last
The application is for enrollment as: *
Address *
Address
Street Name
Suit/Floor/Apt #
City
State/Province
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College/University Information

College/University Address *
College/University Address
Street Name
Suite/Floor/Apt #
City
State/Province
Zip/Postal
Please provide a contact # for financial Aide

Essay

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Agreement

The Conditions and Details of Scholarship Award

Your Leon H. Sullivan Charitable Trust (the “Trust”) scholarship award is for the 2022-2023 academic year (September 1, 2023 – June 30, 2024) and is subject to the conditions listed below. The scholarship must be used for tuition, fees, on-campus room and board, books, and other institutional charges as defined by the finance/bursar’s office at your school. Scholarship funds will be paid directly to your school after the school has returned an enrollment verification, identifying any appropriate student ID number. You must request this from the finance office/bursar at the school. Upon receipt of the Enrollment Verification, the Trust will forward your scholarship payment directly to the school in which you are enrolled. Scholarships are paid beginning in September 2023. We will send one payment for the academic year. The payment shall be applied for the term of enrollment in line with the guidelines established by the school you are attending. Any unused scholarship funds must be refunded to the Trust.

Return the following to the Trust:

Signed original of this Conditions and Details of Scholarship Award Form

Your signature on the Conditions and Details of Scholarship Award Form indicates that you have read and understand the conditions and details and that you accept them as conditions for payment of your scholarship.

Signature

Do you understand and agree to the terms listed above? *