Sam$Houston$State$University$$
Scholarship$Don or$Form$
Cashier’s$Office$
“Your$Success$Our$Goal”$!
Email: cashiers@shsu.edu Phone: 936-294-1083 Fax: 936-294-1229
Student Information
First Name: ______________________ __ MI: ________ Last Name: ________________________
Sam ID: ____________________________ or last four of SSN: ________________________
Donor Information
Organization/Donor: _____________________________________________________________
Address: _____________________________________________ Phone: ____________________
City: _____________________ St: _______ Zip Code:__________
Is the scholarship for: Fall_______ Spring_______ Split Fall/Spring_______ Summer_______
If the student is registered less than full time (12 hrs of undergraduate or 9 hrs graduate) may the student receive this scholarship?
____yes ____no
If the student is registered less than full time and has applied for graduation, may the student receive this scholarship?
____yes ____no
Please include this form with your check as well as a donor letter
Checks must be made payable to Sam Houston State University
(please include student Sam Id on check)
Mail to: SHSU- Cashier’s Office
Box 2273
Huntsville, TX 77341-2273
Once scholarships are received, it will take approximately 7-10 business days for
scholarships to pay towards the student account balance.
Scholarships received 30 days or more prior to the first official class day
will disburse 10 days before the semester begins.
