Student Emergency Support Fund Request
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Student ID Number
*
I am experiencing a financial hardship resulting from an emergency or crisis situation that threatens my ability to complete the current semester successfully:
*
Yes
No
Which of the following possible resources have you considered to assist you through this hardship? (Check all that apply)
*
Income (paycheck, SSI, tax credit, etc.,)
Student loans
Medicaid
Personal financial accounts
Community resources (utility/rental assistance, food bank, etc.,)
Other
None of these
Amount of Funds requested?
*
(Enter the amount that is needed to cover expenses only. Please note that the amount awarded may be less than the amount requested)
For which expenses are you requesting funds? (Check all that apply)
*
Housing
Utilities
Transportation
Healthcare
Books/Academic Materials
Other (open text)
Briefly explain the circumstances that led to your financial hardship and a description of what expenses the funds will be used for.
*
Explain the impact of these unexpected expenses on your ability to remain enrolled at Fletcher.
*
Please attach supporting documentation. Examples of documentation include: emergency medical bills, estimates for repairs, documentary evidence (photographs or videos), letters of support (witnesses of your need), email correspondence related to your emergency situation, financial information, police/fire reports, or other accident reports.
*
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