LEUPP CHAPTER
STUDENT SCHOLARSHIP AND FINANCIAL ASSISTANCE
SEMESTER:
OPENING DATES:
Fall Semester
August 1st
Spring Semester
January 1st
Summer Semester
June 1st
DEADLINE DATES:
August Chapter Planning Meeting Date:
______________________
or August 15th
January Chapter Planning Meeting Date:
______________________
or January 15th
June Chapter Planning Meeting Date:
______________________
or June 15th
No Applications will be accepted before the Opening Dates above for each semesters.
NO EXCEPTIONS.
CHECK LIST
Completed Application
Official Certification of Enrollment of three or more credit hours from an accredited
College/University, Vocational, or Technical School.
Official Grade Report at the end of each semester/quarter:
Official University/College, Vocational, or Technical School Transcript
Official High School Transcripts, GED scores for first year students.
Current Class Schedule on school letterhead
Original Letter of Acceptance from the school
Leupp Voter Registration: Student must be registered voter
Certificate of Indian Blood




Before a potential applicant can be eligible for scholarship assistance, all documents must be submitted
COMPLETELY and ACCURATELY to Chapter Administrative office prior to the monthly Chapter
Planning Meeting in order to be considered for funding at the next Regular Chapter Meeting.
If the student cannot make it to the meeting, they can be represented by a family member.
The Chapter will not accept early applications or faxed applications.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED, NO EXCEPTIONS.
LEUPP CHAPTER
STUDENT SCHOLARSHIP AND FINANCIAL ASSISTANCE
CPO BOX 5013
LEUPP, ARIZONA 86035
TELEPHONE: (928) 686-3227 FAX: (928) 686-3232
pg. 1
The Leupp Chapter Scholarship Policy and Procedures were established to clarify the qualification criteria and
process for The Leupp Chapter students requesting assistance in defraying educational costs while pursuing an
academic degree at an accredited College/University or a certificate at a Vocational School.
1. Each student will fill out and submit the Leupp Chapter Scholarship application for each academic and
summer term (You are only allowed to apply one time every semester or one summer session). All
completed scholarship applications must be submitted before the Monthly Planning Meetings.
2. Each completed application must include:
 Official certification of enrollment of three or more credit hours from an accredited College/University or
Vocational school.
 Official Grade Report at the end of each semester/quarter
 Official University/College and Vocational School Transcript
 Official High School Transcripts, or GED scores for first year students
 Letter of Acceptance
3. Leupp Voter Registration must be attached
4. A signed student contract entered by the recipient and Leupp Chapter
When a completed application is submitted, the documents will be accepted and reviewed by the Leupp
Chapter Administration staff. Thereafter, Leupp Chapter Officials will determine the amount to be
awarded based on the following criteria:





Availability of Scholarship Funds appropriated by The Navajo Nation
University Enrollment and cost per credit hour
Community College Enrollment and Cost per credit hour
Accredited Vocational School Enrollment and costs per credit hour
Recipients must have a current 2.50 or higher GPA and maintain a 2.50 or higher GPA at the end of each
semester or quarter.
Leupp Chapter Resolution with the Award amount will be presented at the Chapter Meeting for final approval by
the Community. Once the Scholarship is approved the Award will be disbursed to the recipient by Leupp Chapter.
If and when this application is approved, I shall accept and abide by the conditions stipulated in the terms above
and will bound by the responsibilities as a recipient of the Leupp Chapter Scholarship and Financial Funds. I,
__________________________, give permission to the Leupp Chapter to receive my transcripts and other
Financial Information Requests.
_______________________________________________________________________
______________________________________
_____________
APPLICANT’S SIGNATURE:
DATE:
TERM APPLYING FOR:
RECEIVED DATE:
(OFFICE USE ONLY)
LEUPP CHAPTER
SCHOLARSHIP AND FINANCIAL
ASSISTANCE
20___ FALL SEMESTER
20___ SPRING SEMESTER
20___ FALL QUARTER
20___ WINTER QUARTER
20___ SPRING QUARTER
20___ SUMMER SESSION(S)
DATE: ____ /____ /____
PERSONAL AND FAMILY BACKGROUND
NAME:
pg. 2
SOCIAL SECURITY NUMBER:
CENSUS NUMBER:
CURRENT MAILING ADDRESS:
EDUCATIONAL BACKGROUND
HIGH SCHOOL/LOCATION:
PERMANENT MAILING ADDRESS:
TELEPHONE NUMBER:
MONTH & YEAR OF GRADUATION OR GED
CERTIFICATE:
TELEPHONE NUMBER:
COLLEGE CLASSIFICATION:
DATE OF BIRTH:
SEX:
MARITAL STATUS: SPOUSE’S NAME:
NUMBER OF
 FRESHMAN
 SOPHOMORE
 JUNIOR
 SENIOR
 GRADUATE CHILDREN:
 POSTGRADUATE
ARE YOU AOR
VETERAN?
ARE YOU
A REGISTERED
MEMBER OF LEUPP
CHAPTER?
COLLEGE
UNIVERSITY YOU PLAN TO ATTEND: (NAME,
CITY
&
MAJOR:
LETTER
OF ACCEPTANCE:
STATE)
 YES
 NO
 YES
 NO
 YES
 NO
TYPE OF DEGREE YOU ARE SEEKING:
CHAPTER RESOLUTION:
AMOUNT OF
REQUEST:
 YES
 NO
$
NAME OF COLLEGE OR UNIVERSITY LAST ATTENDED: (NAME, CITY & STATE)
MONTH AND YEAR
HAVE YOU RECEIVED CHAPTER SCHOLARSHIP & FINANCIAL ASSISTANCE BEFORE?
IF YES, WHEN?
 YES
 NO
MOTHER’S NAME:
FATHER’S NAME:
Roberta I. Gorman, President
Kevin Todacheenie, Vice President
Vacancy, Secretary/Treasurer
Walter Phelps, Council Delegate
Allen Jones, Grazing Committee Member
Priscilla Franklin, Chapter Manager
LEUPP CHAPTER
Telephone: (928) 686-3227 or 3229
CPO Box 5013 Leupp, Arizona 86035
Facsimile: (928) 686-3232
APPLICATION RECEIPT
Applicant Name:
Date received:
Attached
Documents:
Official Certification of enrollment of three or more credit hours from an accredited College/University,
Vocational, or Technical School
Official University/College, Vocational, or Technical School Transcript
Official High School Transcripts, or GED scores for first year students
Leupp Voter Registration: Student must be registered voter
Certificate of Indian Blood
Completed Application, signed and dated
Other:
SEMESTER APPLYING FOR:
Fall Semester – Opening Date: August 1st
Spring Semester – Opening Date: January 1st
Summer Semester – Opening Date: June 1st
Received By:
pg. 3
Date:
Title:
Acknowledge Receipt
(Applicant Name):
Applicant Signature:
Date:
Chapter Planning Meeting Date/Time:
Please keep receipt for your records. A copy will be attached to your original application.
pg. 4