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 (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
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