ADDRESS VERIFICATION – Heyl Scholarships

Heyl Scholars will need to submit this address verification by August 15th annually. Any students making changes to their address throughout the academic year will need to submit a new form.

"*" indicates required fields

Name

First Last

For the upcoming academic year, I am living

On Campus

Off Campus

With Parents/Guardians

On Campus Dorm Name *

Proof of Address *

A Valid Driver’s License, Utility Bill, or Lease Agreement that shows your name and off-campus address can be submitted as Proof of Address.

Drop files here or

Accepted file types: pdf, jpg, png, gif, Max. file size: 5 MB.

Signature