Youngstown State University
Penguins CARE Grant Rent Verification Form
This form is REQUIRED to request funds (up to $2000) for rent coverage via the Penguins CARE Grant. Upon
completion, please present to your landlord/property management company for rent verification and
attach the completed form to the YSU Penguins CARE Grant Application at shorturl.at/uBLQ1 (even if you
have previously submitted the form).
Student Name and Current Address:
Last First Middle
Number Street City State Zip
Rent Information Authorization:
I authorize _________________________________ to release my lease information to Youngstown State University.
Landlord/Property Management Company
Student Signature Date
To be Completed by the Landlord/Property Management Company Representative:
This student has a current lease agreement with _______________________________ at the cost of _____________ /
Name of Property Monthly Rent
through _____________ of _________________. The amount owed to date on this lease is ______________________.
Date Year Current Amount Due
Representative Signature Date
click to sign
signature
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click to sign
signature
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