Emergency Aid Application

Note: Grant does not cover tuition or books.

Student ID #

First Name

Last Name

Gender *

Female

Male

Email *

Address

Apt, suite, etc.

Country

City

State

Zip code

Phone

Best way to reach you

Phone

Are you currently receiving financial aid?

Yes

Are you currently receiving a scholarship?

Yes

If you are receiving aid this semester, have you received a refund check?If you are receiving aid this semester, have you received a refund check?

Yes

Amount of funds requested from Emergency Aid Fund

Have you received Emergency Aid before?

Yes

If yes, date and amount?

Please indicate your household income:

Please describe the nature of your unforseen emergency and the date the emergency occured.

Please explain in detail what the funds will be used for and when they will be needed. Please attach all supporting documents that verify the emergency.

Checks will not be made out to students or to “cash.” Grants will be made directly to source of the emergency (i.e. Landlord, utility company, bank loan, etc.) Please indicate the name, address, and contact info of the payee:

Explain how this unexpected emergency will affect your ability to remain enrolled at Westchester Community College.

Please describe how this grant will help you sustain yourself from this emergency, so that you can continue with your studies at Westchester Community College.

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Westchester Community College, State University of New York

Emergency Aid Application

Note: Grant does not cover tuition or books.

Contact Information

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