Application for Emergency Funds

· The Scholar Emergency Fund provides critical and timely financial assistance to High School and College Scholars experiencing a crisis or transition.

· Funds should be used solely for the purposes of continuing education – tuition, books, housing, transportation, school fees, and other expenditures.

· The emergency fund it to be used as a last resort when other efforts such as self-funding and family funding have not succeeded in meeting financial needs, and the student's ongoing educational process is threatened or limited.

· All elements of the application MUST be filled out for consideration.

Note: Demonstration of financial literacy is a significant component of this application.

Permanent Home Address and Contact Information

College Contact Information

Your Mailing Address at College (include all that apply: Name of Residence Hall, Room #, PO Box, Apt. #, etc.)

Street

City

State

Zip

Your College Email

Part 2- Emergency Funds Request

How much are you requesting in Emergency Funds?

What will these funds be used for?

What is the due date (if any) for this payment?

How did you incur these costs?

Part 3 - Financial Status

Attach a copy (screenshot) of your current academic year financial aid package (who's loans, scholarships, grants, etc.) and current statement (shows charges, payments, and balance due).

College Student Portal Login Name:

Portal Password:

List the amount you spend each month for the following:

Housing (if not living in a residence hall):

Food (if not on meal plan):

Food (in addition to meal plan -- coffee, carry-out, etc.):

Personal expenses (clothing, personal hygiene, etc.):

Transportation (taxi, gas, bus):

Other (be specific)

TOTAL (sum of previous six boxes):

Part 4 - Academic Standing

Academic performance greatly impacts college finances, Scholarships and grants are often tied to GPA.

When do you expect to graduate?

Part 5 - Future Financial Planning

Please list here the last time you connected with your ES College Success Advisor (CSA, i.e. Ms. Nancy, Ms. Bree, Mrs. V, Ms. Lee, or Karina)

Please list which ES College Success Advisor (CSA) you most recently met with.

What will you do in the next few months to make sure that you have enough money to cover your college costs for the academic year? (Be specific: What actions will you take, how will you take action, by when will you take specific actions)?

Application for Emergency Funds - College Years